One of two abortion pills has been added to the list of drugs France considers essential, but it is not among 50 medications that President Emmanuel Macron says will soon be produced locally – even despite a recent shortage that raised questions about France's ability to guarantee the right to terminate a pregnancy.
In early April, midwifes and doctors in parts of France started reporting that they were having trouble accessing misoprostol, one of two drugs used in medical abortions.
“We ran out very soon this year with MisoOne. Then we bought Gymiso and then soon Gymiso was no longer available also in France,” said I sabelle Louis, who works for the Planning Familiale in Paris, a reproductive health clinic that provides contraception and abortions in the city and the region.
MisoOne and Gymiso are the names of the two misoprostol drugs authorised in France, which are both produced by the same pharmaceutical company, Nordic Pharma.
When Louis' pharmacy was unable to source the drug, “ we didn't know how we could provide women with abortion”, she told RFI.
More on the misoprostol story in the Spotlight in France podcast:
Misoprostol, along with mifepristone, is used in medical abortions, which accounted for the majority – 76 percent – of termination procedures in France in 2021.
In April of this year, as pharmacists in some parts of France were unable to source misoprostol, abortion providers became concerned because there is a time limit: medical abortions are allowed only up to seven weeks of pregnancy.
Isabelle Louis recalls not having enough pills for one patient, who had to be sent across town to another doctor.
“Our partner doctor had one more pill left. So we gave the address to our patient and she had to cross all these barriers to get access to her rights,” she said.
Impact of abortion wars in US?
France's misoprostol shortage came as the United States Supreme Court was hearing a case that could ban federal drug approval for mifepristone – part of a move by anti-abortion activists following the overturning of the federal right to abortion last year.
Were American providers stocking on abortion drugs, creating a global shortage?
Pauline Londeix, of the independent Observatory for Transparency in Drug Policies, which was involved in alerting French authorities about the misoprostol shortage, said what was happening in the US was a consideration.
But France has a longer-term, more structural problem with drug shortages.
“There are shortages of about almost every medicines,” she told RFI. “There are shortages of insulin, antiretrovirals, anticancer drugs. There are thousands of medicines for which we are facing shortages and tensions in France.”
Drug shortages in France
Paracetamol was in short supply this winter, as were antibiotics – notably amoxicillin, one of the most commonly prescribed for children – at the height of the flu and cold season.
Over 3,700 different kinds of drugs faced supply problems or risks in France in 2022, compared to 2,160 in 2021, according to data from the ANSM, the National Agency for the Safety of Medicines.
France has been facing drug shortages for several years, linked to a growing global demand for medication, as countries get richer and are able to spend more on healthcare, and pharmaceutical companies fail to keep up with the demand.
For Londeix, this makes it imperative for France to stock up, or to consider producing its own.
“Because let's imagine what can happen if production is concentrated in a country that could declare war on another country – we would be dependent on that country,” she explained, pointing to China and India.
In 2019, the majority of active pharmaceutical ingredient (API) manufacturing sites were in Asia, according to a report presented to the European Parliament.
“If China decides for whatever reason to close its borders to the exportation of medicine, then we will have a problem,” said Londeix.
In 2020, during the Covid pandemic, when France was facing a shortage of Doliprane and other painkillers containing paracetamol, French President Emmanuel Macron said that he would make sure the API was produced in France by 2023 – without success.
Today, while three companies produce paracetamol drugs in France, the API is still sourced from the US, India and especially China.
“Delegating to others the production of our essential pharmaceutical products puts our country in a deadlock,” Macron said mid-June, when he presented a plan to start producing some drugs in France.
A first list of 50 essential drugs – including amoxicillin, morphine and six cancer drugs – “will see their production moved to or increased significantly to France… in the coming weeks”, he said.
A second, longer list of 450 drugs includes misoprostol, for which “securing supply chains will be a priority”.
Drug companies will be required to keep four months' worth of these drugs in stock, according to Health Minister François Braun.
Protecting access to abortion
Left-wing lawmakers, concerned about leaving abortion medication concentrated in one producer, introduced draft legislation that would require a public production of mifepristone and misoprostol “to guarantee the fundamental right to abortion”.
Londeix welcomes moves to produce more medication in France, and a push for public production, but with abortion drugs, she is cautious.
“ Public production is important, but in this specific case we think that we also need private production. We need both, because if there is a switch of governments in France, and the extreme right, for example, accesses power – if there is public production only, it can be a problem,” she said.
After several warnings about the misoprostol shortages in April, the Health Ministry responded saying there were no shortages, only “tensions ” .
Pharmacists were able to get supplies of the medication intended for Italy. At the family planning clinic in Paris, Louis received boxes labelled in Italian, with stickers added in French.
“For the moment, we are probably back to normal,” she said recently. “But we don't know how long it will last. ”