The medical construction of gestational age and its effects on abortion access

This article examines how medical practices construct gestational age and affect access to abortion care. While abortion laws typically establish gestational limits, the clinical determination of gestational age remains a medical responsibility, requiring healthcare professionals to interpret and apply these limits through various dating methods and practices. Based on ethnographic observation in three French abortion centers and interviews with 133 healthcare professionals, this study reveals significant variations in dating practices. These variations occur at three levels: the moment chosen for dating (consultation versus procedure day), the method chosen for dating and the measurement rules applied when pregnancies are dated by ultrasound. The study demonstrates that these technical choices result from negotiations and sometimes conflicts among physicians with different dispositions regarding women's reproductive autonomy and fetal interests. Consequently, a woman might be considered eligible for legal abortion in one center but beyond the legal limit in another. This creates a previously undocumented form of inequality in abortion access that operates through seemingly objective medical instruments. The analysis contributes to understanding how healthcare professionals serve as "legal intermediaries" who must interpret the law through technical devices to apply it. It also reveals how medical instruments, while appearing as objective clinical tools, function as political devices that define in practice what abortion and the right to abortion are. These findings have significant implications for reproductive health equity and policy implementation beyond the French context.