The Contraception World Day, on 26th September, was an opportunity to observe the current trends in France on the subject. This day, now the 17th, is a platform, supported by the United Nations Population Fund (UNFPA) for the promotion of information and use of contraceptive methods.
What are the current trends regarding the use of contraceptive methods?
Surveys by public institutions such as INSERM and INED have for several years revealed a decrease in the use of female hormonal contraception (contraceptive pill). According to an article published in The Conversation which is based on those studies, in 2019, 26% of women between the ages of 15 and 49 were users. In 2005 they were 47%. The downward trend had therefore already begun and the figure dropped to 36% in 2010.
Various events, such as for example the scandal of the 3rd and 4th generation pills, revealing the harmful side-effects could have contributed to the disaffection for such hormonal methods. Several scientific studies also pointed out the additional risks in several domains : breast cancer, mental health, stress management (see our article on the subject here).
More recently, a new sanitary scandal associated with a progestogenic medicine prescribed, among others, as a means of contraception, has highlighted the question of side-effects and the completeness of information provided to patients. Stirring witness accounts, such as that which was published in Ouest France during the summer, underline the lack of reliable information given to patients. According to the President of the Amavéa association, which provides support for women victims of meningioma associated with taking progestins: “In 90 % of cases, the women are angry. They wonder why they were not warned beforehand. In at least half of those cases, they were in therapeutic vagrancy.”
Another trend stresses the need to balance the responsibility between women and men regarding the use of contraceptive methods. The perception of the hormonal pill has evolved on the subject. In 2017, on the 50th birthday of the Neuwirth law, France Info broadcast a programme titled “The contraceptive pill, 50 years of freedom”.
Today, many articles or programmes on the subject use the expression “contraceptive mental load” to describe the asymmetry introduced by the hormonal contraception devices for women (pill, intra-uterine device etc.). Witness accounts published by women illustrate these negative aspects: absence of regular dialogue within the couple, lack of acceptance by men of the constraints and side-effects of the pill for women, wish for a more ecological approach.
In line with the challenging of the type of contraception managed by women, the practice of vasectomy is on the increase in France. In 2024, the French Assurance Maladie published some figures. They show that “The number of vasectomies has risen steeply in France since 2010, with a yearly rate multiplied by 15 over 12 years (from 1,940 in 2010 to 30,288 vasectomies in 2022).” As a percentage of the masculine population, the figure remains very low compared with other nations. According to an international study published in 2021, vasectomy is practiced by 20% of men in the United Kingdom and 15% in Canada.
Contradictory signs exist however concerning this trend on the use of this masculine contraception method. Moreover, the WHO published a study during the summer, indicating that the use of condoms was diminishing among the younger populations. The study covered a vast sample (242,000 young people, in 42 nations). The age of the participants (15 years) is nevertheless a serious limitation for any extrapolation towards a more general trend of the population.
Despite these evolutions, natural birth regulation methods are often sidelined in the presentations by the media for the general public. The CLER web-site however underlines the benefits of such methods in order to meet the needs described above: more regular dialogue within the couple, absence of medicinal impregnation to avoid harmful side-effects, better acceptance and respect for the biology of women.
The limits of an approach which dissociates sexuality and procreation
Scientific information is available to highlight the impossibility of totally dissociating procreation and sexuality. The experts often distinguish between theoretical efficiency and practical efficiency, which considers the imperfections of use in the real world. The WHO has published a table providing a measure for efficiency: the rate of pregnancy for 100 women using the method considered. One point is clearly shown: under the “as commonly used” column, no method attains an efficiency of 100%.
Even with so-called definitive contraception methods like vasectomy, there remains a low (0.15%) but real probability of pregnancy. A witness account published during the summer in Marie-France magazine offers a concrete illustration of such a probability.
This should encourage the public authorities and education players to present contraceptive methods in their entirety. The expression “contraceptive paradox” describes the fact that many women who resort to abortion were using a contraceptive method (a figure of 72% was given in a report by IGAS published in 2010).
The argument for dissociation is therefore found wanting in real life situations. The abortion figures published this week, with a record level of 243,623 abortions, illustrates the urgency for a comprehensive approach on the subject. Communications around the theme of contraception could usefully refer to it during the opportunity of the World Day.
