According to the latest World Health Organization ranking, France holds the title for the best healthcare system in the world. Sécurité Sociale, the French national health insurance system, even comprehensively finances assisted reproductive technologies (ARTs). To date, more than 20
0,000 children have been born from French ART services and France has the most fertility clinics in the world. However, government legislation tightly controls access to ARTs—only heterosexual, young, medically infertile couples that have been married or have cohabitated for at least two years are eligible.
This narrowly d
efined access to ARTs came about as part of a flurry of bioethics legislation passed in 1994. Beyond simply direct legislation, however, Dr. Melanie Latham attributes the root of restrictive ART regulation to the French civil law code in general. In Regulating Reproduction: A Century of Conflict Between Britain and France, Dr. Latham writes that the French government is much more reliant on preemptive, all-inclusive legislation than the governmen
ts of the United States or United Kingdom. The U.S. government, for instance, has practically no supervisory role in the ART market, meaning that ART access for homosexual couples, single women, and older women is limited only by their ability to pay.
Perhaps the most contentious point of debate is the explicit requirement that ART treatment be given only to heterosexual couples. The exclusion of homosexuals is sometimes defended under the idea
that homosexual couples cannot naturally have children. The inability to conceive a child would therefore not be a sign of a medical condition, so homosexual couples could not be deemed in need of a therapeutic treatment. In addition, gay male couples using ARTs would require surrogate mothers. However, surrogacy is illegal in France as part of a system that is averse to bodily commoditization in general.
The French p
rimarily justify this controversial restriction based on the guiding principle of projet parental (“responsible parenthood”) which necessitates screening for “good” parents. The article “AMP: L’assistance médicale à la procréation en pratique,” written by Dr. Jacques Lansac, the Chairman of the French National College of Gynaecologists and Obstetricians, and Dr. Fabrice Guerif, further explains projet parental as the valuation of the potential chil
d’s right to adequate parents over the potential parents’ right to have a child. The French government has used projet parental to limit the term “optimal parenthood” to heterosexual couples.
At first, this requirement seems inconsistent with the liberal and secular image of the French state, which
established registered domestic partnerships in 1999 and banned LGBT-targeted hate speech in 1995. But these restrictions on ART access clearly reflect a more conservative stance on the value of the traditional family structure.
France’s heterosexuality requirement has remained even after reviews of its bioethics laws in 2004 and 2009. This decision was supported by popular opinion expressed to the French general assem
bly as well as a 2005 L’Encephale study that found a consensus in physician opinion that homosexual parentage might result in children with developmental problems. However, there have been some voices of dissent from the Socialist Party, notably in the 2007 presiden
tial race between Segolene Royal and Nicholas Sarkozy. Royal supported gay marriage and full rights to adoption and ARTs, stating simply that “the fundamental question is that of discrimination” in a 2006 interview with Tetu Magazine.
The heterosexuality requirement on the basis of projet parental is an example of how an ART policy that manages to transcend socioeconomic class has nevertheless led to the marginali
zation and devaluation of a minority in French society. Ultimately, the French government’s decision-making authority on questions of ART access is derived from the financial control of the Sécurité Sociale and executed through the regulatory authority of the national French Biomedicine Agency. If these institutionschoose to invoke principles of social conservatism, it becomes law. We can only hope that these governing bodies will reevaluate their definitions of parenthood in the next round of bioethical legislation review.