Sex ratio at birth for urban and rural areas
Bohua, L.
China Population Newsletter 3(2): 7-9
1986
ISSN/ISBN: 1000-9043 PMID: 12268065 Document Number: 345449
Despite its simplicity and freedom from complications, vasectomy in France faces significant legal, bureaucratic, political, ideologic, psychological, and medical obstacles. Legal obstacles are the most important inasmuch as a principal of French law holds that the individual does not have free disposition of his body. The sole existing French jurisprudence on the question equated male sterilization with premeditated assault and battery. Although no physician has been prosecuted for performing vasectomy since this 1936 Court of Appeals decision, physicians performing vasectomies remain somewhat at the mercy of the caprices of the magistrate. Social security refuses to pay for sterilization performed for contraceptive reasons, which may discourage low income candidates. The Council of the Order of Physicians opposes vasectomy because of its legal status and because article 22 of the Medical Code states that sterilization can only be performed for very serious medical indications. In 1983 the Council changed its recommendation to "very serious indications", dropping the word "medical", but it does not vigorously support vasectomy because of the legal question. Malpractice insurance coverage of vasectomy practitioners is based on whether the results of criminal trials indicate that the operator violated the penal code; the hazy legal status of vasectomy therefore makes insurance coverage unlikely. Political obstacles to vasectomy are far from resolved. No party has openly supported voluntary sterilization, less because of ideological or demagogic considerations than because of the fertility decline in France. Public opinion might question a law authorizing definitive contraception at a time when the replacement of generations is not even assured. Religious objections to contraception in general and sterilization in particular remain strong. A 1978 survey of 1273 French doctors showed that 35% of practicing Catholics but 61% of nonbelievers among them had favorable attitudes toward contraceptive sterilization. Psychological obstacles stem from the danger that vasectomy will be equated to castration. Careful preoperative screening is needed to exclude men likely to suffer impotence or other side effects. The major medical obstacle to vasectomy is its uncertain reversibility. For legal and other reasons, the vasectomy operator should carefully screen each couple, require a 2-3 month waiting period, obtain informed consent, provide a specimen for a sperm bank, limit the operation to men aged at least 35-40 years with 2 or 3 children, and obtain a psychiatric evaluation of the motivation and stability of the couple.