Midwives were thought to be confined to the delivery room: 87% of French women don’t know what she can do on her own since 2009
A health profession can hold considerable power without the general public having the slightest idea, and this is exactly the case for midwives in France. If you ask ten people nearby what she is authorized to do, nine will probably answer to deliver babies, end of story. Yet this profession has undergone a truly silent revolution since 2009, a transformation so discreet that 87 % of French women still do not know it exists. Between medical prescriptions, gynecological follow-up, and actions once reserved for doctors alone, today’s midwife has little in common with the old image that still clings to her.
- Since the 2009 HPST law, the midwife can independently provide preventive gynecological follow-up for healthy women, without a doctor’s involvement.
- She can prescribe contraceptives in all their forms, including to minors without parental consent, and perform medical abortion since 2016.
- Since 2022, she can also screen for and treat sexually transmitted infections in couples, and a proposed law aims to authorize her to prescribe renewals of sick leave.
- The law that changed everything without anyone knowing
- Much more than childbirth: autonomous comprehensive gynecological follow-up
- Contraception, sick leave and medical abortion: these actions you didn’t know about
- Why this little-known status concretely changes French women’s access to care
The law that changed everything without anyone knowing
It all starts with a text that isn’t a media event: the HPST law (Hospital, Patients, Health and Territories), promulgated on July 21, 2009. Behind this technical acronym lies one of the most structuring texts for the midwifery profession in France. It officially grants her the ability to ensure the preventive gynecological follow-up of any healthy woman, without a physician needing to intervene upstream. This legal shift moves the midwife out of her historical role, limited to the delivery room, and places her in a much broader care pathway.
Article L.4151-1 of the Public Health Code clarifies this framework: the midwife can carry out contraception consultations, perform a comprehensive preventive gynecological follow-up, and even practice certain procedures formerly reserved for gynecologists, provided she directs the patient to a doctor as soon as a pathology is detected. In other words, she becomes a true first point of entry into the female health system, on par with an ophthalmologist or a gynecologist with direct access, without mandatory passage through the general practitioner.
Much more than childbirth: autonomous comprehensive gynecological follow-up
Concretely, a healthy woman can now consult a midwife for her Pap smear, her breast exam, or her annual gynecological consultation, without ever crossing paths with a physician in this care pathway. This follow-up encompasses prevention, screening, and support, year after year, for all patients without particular complications. It is a paradigm shift that took time to take root in the public’s mind, given how the image of the midwife remains almost exclusively associated with birth.
Since a March 2022 decree, this scope of action has expanded even further: the midwife can now prescribe screening for sexually transmitted infections and propose first-line treatment, both for her patient and for her partner. A development that considerably simplifies the care pathway in a field where appointments with a specialist doctor can sometimes be counted in weeks. France today counts about 24,000 practicing midwives, of whom over 97% are women, and their scope of competencies is regarded as the broadest in Europe.
Contraception, sick leave and medical abortion: these actions you didn’t know about
If gynecological follow-up already surprises many French women, the list of possible prescriptions pushes astonishment even further. Since an order dated August 8, 2016, the midwife can prescribe contraceptives in all forms and routes of administration: the pill, implant, patch, emergency contraception, or an intrauterine device. She can even issue these prescriptions to minor patients, without going through parental consent, a point often misunderstood that eases access to contraception for adolescents.
Another competency widely unknown to the public: since 2016, midwives are authorized to perform the medication-based abortion, an act that previously belonged exclusively to doctors. This capability is not trivial, as it directly helps shorten the waiting times to access this right, especially in areas where medical services are scarce. Added to this is a more recent development: a bill led by deputy Stéphanie Rist, adopted in a first reading at the National Assembly, would authorize midwives to prescribe renewals of sick leave. Moreover, a decree of August 8, 2023 expanded their vaccination competencies, further strengthening their role as a nearby health professional.
Why this little-known status concretely changes French women’s access to care
This generalized lack of awareness is not without consequences. In a context where many French territories face a shortage of gynecologists and general practitioners, the midwife represents a nearby solution that remains largely underutilized. How many women forego gynecological follow-up because there are no available appointments with a specialist, when a midwife could have seen them more quickly, with the same skills for a standard health journey?
As the new school year approaches, when medical offices often display weeks of waiting times, reminding people of this little-known status makes sense. The midwife is no longer only the professional you meet on the day of delivery: she accompanies women throughout their reproductive lives, from adolescence to menopause, through contraception, prevention, and, now, certain sick leaves. This gap between the legal reality of the profession and the public’s perception illustrates how poorly information about health rights circulates, even though it could ease an already strained system.
Ultimately, the French midwife today holds a scope of competencies that few European countries offer this profession, including complete gynecological follow-up, prescription of contraceptives, medication-based abortion, and soon sick-leave renewals. While this status remains largely unknown to the general public, the real question may be this: how many French women could gain valuable time in their health journey simply by knowing how much this professional can act independently today?
