“To your uteruses, ready…IVF!” » Emmanuel Macron took advantage of his big press conference yesterday to announce a big race against the decline in the birth rate in France, like a biathlon pursuit. The president noted a fertility rate at half mast, and wants to catch up with the bar of two children per woman. In the charger of his “demographic rearmament”, Martin Fourcade of the Elysée placed a bullet called “plan to fight against the scourge” of infertility, which has “progressed a lot”.
But is there really an increase in infertility on a medical level? What can this plan contain to improve the fertility of French people? Is this a real public health issue or a political communication trick? 20 minutes takes stock with Doctor Nasrine Callet, gynecologist at the Institut Curie.
Is infertility really on the rise in France?
According to the definition of the World Health Organization (WHO), infertility is considered to occur after 12 months of unsuccessful pregnancy attempts in a couple. Which represents, according to a report by Professor Samir Hamamah and Salomé Berlioux in 2022 submitted to the Ministry of Health, one in four couples and 3.3 million French men and women. “There is an increase in infertility from a medical point of view, but not that significant,” says Nasrine Callet.
The gynecologist evokes a “multiplicity” of factors, starting with “exogenous” causes, and in particular cancers. She also points to “pollution, pesticides”, particularly in the increase in male infertility, and the “stress factor”. “The uncertainty of life, the fear of war, the instability of employment, the financial factor”, lists the doctor, are all elements which can play a medical role as well as lead to “voluntary infertility” . “Around the age of 30, around 35% of women do not want children,” she says. A figure close to that of an Ifop survey, in which 30% of women of childbearing age declared not wanting children.
How can we fight infertility?
But let’s refocus the problem of infertility on those who want children. How to help them? For Nasrine Callet, the government can act on several scales. Starting by providing resources. “We lack PMA centers, the delays are very long,” she begins. The long-standing commitment of the Head of State to facilitate recourse to PMA, including for single women, could go in this direction.
The gynecologist also defends the importance of “raising awareness among doctors” and “setting up infertility research consultations”, and insists on “reimbursement and care”. More broadly, she invites the government to pursue “a policy to combat pollution and anything that can deteriorate” fertility. Thus, the 2022 report points to factors linked to lifestyle (obesity, tobacco, alcohol, etc.) in the decline in fertility. In the longer term, investment in research is also necessary, particularly to improve the condition of women with endometriosis.
Is this a public health issue or primarily a political and economic question?
This decline in fertility is not new, even if it is accelerating. Above all, it must be put into perspective in view of the exception that France has long been in Western countries. Faced with an aging population, the question of the birth rate “intersects with that of pensions and economic immigration”, two hot topics in 2023 on the political level, notes Nasrine Callet. “The essential goal is not to take care of infertile women,” she says.
The subject is not new to Emmanuel Macron’s target. The plan to combat infertility was already provided for by the bioethics law of 2021, and had also led to the submission of the report in 2022 to Olivier Véran. At the time, the executive assured that it wanted to transform this report into “a strategy to fight against all causes of infertility for spring 2022”. With a Minister of Health who opposed Marriage for All and then the extension of the offense of obstructing abortion behind the gun, is this strategy starting from scratch with Emmanuel Macron’s announcement, or will it finally come into force?