Academic Corner General

Legal contraceptive sterilization in France, or yet another trap of the French bureaucracy

The exceptional legislative measures taken by the French government since the COVID-19 pandemic illustrate the country’s procreative social norms: parents have been intensely supported, guided and assisted during the crisis. Not surprisingly, although procreation is addressed as a public issue, the right not to procreate has mostly been repressed. Sterilization as a definitive contraceptive method was legalized in 2001 in France, following intense debates on sexual and reproductive rights. However, does the reality of the sterilization process illustrate the straight-forwardness and accessibility of legal texts? Through a focus group I organized, participants showed otherwise: gynecologists are complicit to the pronatalist French government, which manipulates its population into procreating to activate generational renewal. This illustrates a highly complex and layered system in which culture, health and education, amongst others, intertwine with each other, striving for the accomplishment of political goals.

Written by Solène Prada Paz

  1. Introduction
    1. Problem definition and research question 

Since the beginning of the COVID-19 pandemic, the French government took exceptional legislative measures to adapt the law to this extraordinary situation. Amongst them, six decrees especially targeting the parent group of France’s population passed between April 2020 and 2021. Those decrees include financial compensations, allocation of diverse resources, and lighten yet compensated working schedules. While these legal evolutions are peculiar to the pandemic context, they fit into the scheme of the procreative social norm France has developed over time. 

Indeed, procreation questions are addressed in the public domain in France. The government introduces reproductive rights policies in line with their social and economic impacts. In other words, sexual and reproductive rights are only respected by a country if they are deemed to be in line with its political, economic and social interests. Through discourse, public services, law proposals, images, and more, the French government intends to push (especially heterosexual) couples to reproduce themselves to secure a new generation of future workers who will finance the retirement of the elder population. In other words, the French government shares the following message: generational renewal is more important for society than reproductive individual freedom. 

Moreover, I argue that reproductive rights also include the freedom to non-reproduction, which is a subtlety that is often disregarded. One can think of (consensual) sexual activities being performed not with the goal of procreation but the ones of pleasure, discovery, and/or other instead. However, with a Judeo-Christian government and cultural hegemony in place, France has failed to acknowledge, respect and advocate for such. 

In line with the topic of non-reproduction, I particularly tackle one specific medical service: the one of permanent contraception for individuals with a uterus. Considering the above, how do France’s sterilization policies go in line with the country’s pro-natalist perspective? 

I will first offer a contextualization of access to permanent contraception in France. Then, I will analyze primary sources, including the law relative to sterilization and other relevant legal tools. Simultaneously, to illustrate this section, I will use direct experiences of (to-be and already) sterilized individuals by presenting their input in a focus group I organized.

  1. Existing literature and conceptualization

The main and aforementioned concept of reproductive rights is based on the one of gender. Over time, the latter has been analyzed through different theories. Connel recognized three of these, which respectively built upon the former one, identifying its failures and attempting to fill its gaps: categorical, poststructuralist, and relational theories. I will use the latter for my research, as, instead of understanding gender as a biologically centered traditional feature, it embraces several types of relations (economic, power, affective and symbolic) at different levels (intrapersonal, interpersonal, institutional, and society-wide). Indeed, when analyzing the role of gender in public policies, it must be understood as a multi-layered and highly complex matter that is not easily definable as it is not motionlessly set in biology but meant to contextually transform itself instead. Finally, I will not be relating to the binary categorization of “men” or “women”, but to “individuals” instead.

Now that the concept of gender has been defined, the one of reproductive rights can be assessed. France witnessed the following evolution in terms of sexual freedoms. Until 1999, rights were only targeting procreative actors, with a focus on maternal health. The Téhéran declaration of 1968 pointed out the right for parents to choose the number of children they wanted to bear, and the rhythm of reproduction. In 1981, the Vienna conference defined access to family planning as a fundamental human right. The neo-Malthusianism theory was planting its seeds all over the world, warning about overpopulation and overconsumption threatening environmental wellbeing. At the birth of the XXIth century, reproductive rights had redefined themselves based on plurality: it was about decision-making, access, consent, equality, legal status, safety, and education, instead of mere parenthood. Those freedoms expanded to the civil, social, and political spheres, illustrating the inherent intersectional nature of gender. With it came a new idea, which lays at the heart of this research: reproductive rights also include the right to non-reproduction. 

Two decades later, the battle is not over. “The right to reproduce is as much at stake as the right not to”: Browne advocated for the deconstruction of social standards by erasing the circular link between “pregnancy” and “women.” The dominant ideas of pregnancy are still based on a “patriarchal, heteronormative cisnormative government of reproduction”. 

  1. Methods and data

The data used in this research include primary sources and secondary ones. The former gather article 26 of law n°2001-588 of July 4th 2001, about the legalization of sterilization in France, and an informative booklet tackling sterilization which gynecologists must give their patients. Discourse analysis will be used to analyze primary sources. It is an interpretative and qualitative method that roots itself into both the contextual knowledge of the content and the substantial part of it. It is concerned with questions of power, and often with issues revolving around institutional hierarchies. It is quite useful here as I engage with a governmental source that has direct implications on a group of the population. It is thus inscribed in an institutionalized and hierarchical framework that cannot be ignored. 

Secondary sources include a focus group I organized with sterilized and to-be-sterilized French individuals. I first interacted with members of a Facebook group called “Voluntary Sterilization”: an inclusive, benevolent and instructive platform for people to discuss, question, and inform themselves on the topic of sterilization. Then, I privately contacted 20 of them, with whom I shared my wish to voice their experience in this research. The ones who agreed, 16 in total, are aged 19-42 years old and are either in the process of getting sterilized or have already gotten surgery. I set up two Zoom meetings in which all participants took place, and from which the quotations that will be used in this paper were gathered. As members and I have signed an agreement of anonymity regarding this research, I will be using fake names in this paper. 

  1. Analysis
  2. Historical and social contextualization

Sterilization as a mode of contraception went through several steps before being legalized. It all started in 1996 after the French Society of gynecological endoscopy estimated between 30 000 and 40 000 sterilizations were effectuated each year. At the time, this surgery was only allowed for therapeutical purposes, thus not as a contraceptive option. In 1999, article 16.3 of the civil code was modified and allowed sterilization -in other terms “the damage to the integrity of the human body” for medical necessity, in addition to the therapeutical purposes. 

In 2001, the 1975 Veil law about abortion and contraception was to be rewritten. Deputies jumped on the occasion to share their law proposal on sterilization as definite contraception. The Senate first challenged them by making amendments -enforcing restrictive access conditions- but in vain. The deputies’ text prevailed, and France legalized sterilization on July 4th, 2001. 

Since then, the legal process to become sterilized in France is rhythmed by four steps. The first one is informative: patients articulate their demand to get sterilized to a gynecologist. The latter informs them about medical risks during and after the intervention and hands out an information booklet about contraceptive sterilization. The second step is reflective: right after the first consultation, there is a mandatory 4 month-long “reflective period” for patients to thoroughly consider their decision and to ask questions to health professionals if needed. Following this period, the third step takes place: patients visit the gynecologist again, signing and testifying the confirmation of a contraceptive sterilization request. This is a quite straightforward stage, in which the gynecologist will set a date for the final step: the surgical intervention. Finally, the patient is sterilized in a health institution by the aforementioned gynecologist or by another surgeon who agrees to offer this service. Contraceptive sterilization can take place in two different ways: by tying and severing the tubes or by electro-coagulating them. 

  1. Conflicting theory and practice: the “ought to be” VS reality 

There are two relevant primary sources to be analyzed in this section. The first one is article 26 of French law relative to abortion and contraception (Appendix A and B). It is the short text which was passed on July 4th 2001 and legalized sterilization as a contraceptive method. It is necessary to examine its terminology, as it illustrates the perspective of the government on this practice. The second source is the booklet that gynecologists hand out to their patients on the first consultation. This informative file is greatly significant for this research, as it is written by the French Minister of Solidarities and Health and is automatically given out to the concerned individual. Thus, as its presence is a non-negotiable step of the sterilization process, it is a non-negligible aspect of this paper. 

On the first hand, Article 26 is a 178-word straight-forward text that is divided as follows: first (four lines-long), it lays the conditions of the individual that is willing to get sterilized. They must be major (18+), consensual and free from any time of manipulation from another person (“free desire”). 

This information seems to be fundamental as it is the first one stressed in the law. Nonetheless, Paul, a participant of my focus group, witnessed otherwise in practice. They attended a clinic in North-East France, in which their gynecologist handed them a form on which their partner was meant to testify the approval of this decision. Following up on Paul’s comment, Camille declared having gone through the same situation. An unprofessional and illegal faux-pas that implies that patients must be part of a couple to obtain sterilization, with a dependency on their partner to take decisions relating to their bodies. 

Furthermore, article 26 puts an emphasis (over nine lines) on the rights and duties of gynecologists. The function of the latter is strictly informative at first, as they “must, as early as possible,” inform the patient about the medical risks of the surgery. I observe here the priority given to the acknowledgment of the potential dangers of sterilization, instead of other information such as a descriptive explanation of the surgery or the medical support patients can benefit from during the process. 

In the focus group, Grégoire described their discussion with the doctor about the potential risks.

Meanwhile, in total opposition to the high-responsibility speech just mentioned, the very last section of the text stresses that a doctor is never forced to offer contraceptive sterilization. I believe this sentence to be extremely crucial in the understanding of the government’s perspective. Firstly, because it highlights doctors’ ability to refuse to deliver this service, though in the context of contraception only. In other words, if it was for medical or therapeutical purposes, they would have to sterilize the patient. However, if it is the patients’ deliberate choice to get their tubes tied outside of a physical health risky situation, then their decision might be met with the health professional’s veto. Secondly, because contraceptive sterilization and abortion are the only two services French doctors can refuse to deliver. Indeed, out of every operation legally offered in France, these two -explicitly relating to the bodies of a specific group of the population- are the only ones that can be denied assistance despite the professional’s capabilities. 

Thanks to the focus group, I understood that this refusal can be explained via several reasons: the patient’s age, relationship status, their situation regarding parenthood (if they have had or not children in the past), their history of abortion or miscarriage… 

On the other hand, the informative booklet handed by gynecologists to their patient is a 29-pages long source of data. It is divided into three sections: a short one (two pages) regarding the aforementioned conditions and steps to get sterilized, a longer one on the methods and consequences of sterilization (five pages), and the last one on alternative contraceptive methods (five pages). I interpret this organization as manipulative and not effective. This file called “Sterilization with a contraceptive aim” offers, in terms of length, as much content on alternative contraceptive options than on sterilization itself. Additionally, it ends with this extensive description of condoms, pills, implants, and more, which I interpret as having a convincing aim.  

Blandine experienced the real-life illustration of what I argue above. 

Moreover, I now move from the booklet’s form to its content. On page 4, it is again stressed that if the doctor is not willing to practice contraceptive sterilization, they are absolutely allowed not to do so. This conscious clause, which allows doctors to pick which surgeries to exercise and those not to, is highly discriminatory. It illustrates a professional privilege that has life-long implications on the lives of the patient. Religious, ideological, or philosophical spheres should not interfere with opportunities for patients to benefit from a secure (legal) health service. By allowing health professionals to refuse to offer such (categorical understanding of) gender-specific assistance, the French government is an accomplice to this discriminatory practice.

Finally, the booklet also stresses the possibility for doctors to offer “help in the process,” may it be psychological, psychiatric, or conjugal assistance. This is expressively introduced as an opportunity offered to the patient by the gynecologist using the verb “can”, but not as an obligation (“must”). No later than in February 2021, George experienced a different scenario: 

George’s testimony demonstrates the ability and total impunity of doctors to make their demands and set their conditions regarding sterilization. Psychologist assistance should only be voluntarily offered to the patient, while George’s doctor made it an obligation for his patient to have access to the medical service and get a “pass” from the committee. 

  1. Conclusion 

The legal framework and the focus group members’ experiences have helped identify the numerous flaws of the current situation around contraceptive sterilization in France. I argue these are the consequences of a top-down process that not only allows such failures to emerge specifically for this operation but also to turn a blind eye on them. Gynecologists are given the tools to impose their judgment upon their patients, adding conditions to the estimated-too-accessible law. 

Two dominant spheres are to be identified here: Politics and Culture. Politics, via its actors, pushes natalist goals. France is the first country to have initiated a demographic transition in the XVIIIth century. Since the end of the Franco-Prussian war (and later after the two World Wars), the government used natalist discourse to repopulate the country. Additionally, France legalized contraceptive sterilization very late compared to other countries (Appendix C). I argue that the impact of policies on society is proportional to the length of time they are implemented. This bridges the hiatus between Politics and Culture. Indeed, the generation that witnessed the legalization of definitive contraception exactly 20 years ago, is the one that is still active today. Thus, French society still sacralizes maternity and conceptualizes individual’s accomplishments through procreation. Just like the government is a Political actor, health professionals are Cultural agents. By that, I claim that most doctors bear society’s dominant norms. 

We are thus witnessing a complex societal apparatus that functions through the mutual support of several fields, such as Politics and Culture, but also Education. In French middle schools, when tackling the reproductive system and contraception in science class, sterilization and vasectomy are not part of the syllabus. They are censured by cultural agents who feed on the existing system that promotes a natalist lifestyle.  

Finally, to answer the primary question, France’s sterilization policy goes in line with the country’s pro-natalist perspective as it devotes most responsibilities and the final decision to the gynecologists, paternalistically infantilizing their patients. For this case, reproductive rights are far from being individual rights: though they claim to be so (as they relate to each person’s ability and desire), they are actually trapped in the very famous French bureaucracy. 

Finally, taking into consideration this research, I urge France to rethink its sterilization policy, embracing the human rights approach from the 1970s which promotes individual rights instead of a state’s needs-centered approach. 

Although this research has been very helpful in pointing out the flaws of the current situation regarding contraceptive sterilization in France, I observe two main limitations in terms of the used data. First of all, I only included in the focus group volunteers from one Facebook group. Thus, I did not voice the experiences of individuals that are not active on this social media, or that are unaware of the Voluntary Sterilization community. Second of all, my data lacks intersectionality. While white individuals are constraint by the above repressive legislation, People Of Color (POC) specifically have and still are being prevented to procreate in France. In the country’s overseas department (formerly colonized by the European country), POC have faced political measures aiming at discouraging their fertility. For instance, family allocations would decrease for each new child, while they would increase in continental France. Also, contraception was introduced in those departments earlier than in Metropolitan ones in order to control better the local’s fertility. 

Finally, taking into consideration this research, I urge France to rethink its sterilization policy, embracing the human rights approach from the 1970s which promotes individual rights instead of a state’s needs-centered approach. 

Browne, Victoria (2018) The Politics of Miscarriage, Radical Philosophy, Vol 203

Bureau, A. “Stérilisation à visée contraceptive La loi du 4 juillet 2001 quel changement ? ». ttp:// Consulted on May 6th 2021. 

Gautier, A. (2000). Les droits reproductifs, une nouvelle génération de droits ? Autrepart (15), 167-180. 

Livret d’information. « Stérilisation à Visée Contraceptive ». Consulted on May 6th 2021. 

Raewyn Connell (2012) Gender, health, and theory: Conceptualizing the issue, in local and world perspective, Social Science & Medicine, Volume 74, Issue 11, Pages 1675-1683,

République Française. « Allocations destinées aux famillesé. Consulted on May 6th 2021. 

République Française. « Loi n°2001-588 du 4 juillet 2001 relative à l’interruption volontaire de grossesse et à la contraception ». Consulted on May 6th 2021. 

Schneider, F. (2013). Getting the hang of discourse theory, Consulted on May 7th, 2020. 

Sénat. “Projet de loi relative à l’interrption volontaire de grossesse et à la contraception”. Consulted on May 6th 2021. 

Serment d’Hippocrate. Consulted on May 6th 2021. 



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Hi there! My name is Sol (she/her). And that’s about it… To be honest I always have a hard time introducing myself, I always end up introducing my areas of interest instead. I’m pretty sure they define me more than my age, nationality or educational/professional status anyway… So here it is: I’m guessing that if you’re reading this, we share the concern of feminism (yay, we’re already a bit less than strangers!), I’m also deeply triggered and interested by ecological topics and post-colonialism. These three are intrinsically connected and my aim through my daily research, conversations and artistic discoveries is to better comprehend this connection, and to strive for a better today and tomorrow.