Fellowship opens door to comprehensive abortion access coverage in U.S., France

Ariel Cohen, a health policy reporter for CQ Roll Call, recently completed a comprehensive series of six stories examining abortion care policies in the United States and France. This in-depth reporting project, made possible through AHCJ's International Health Study Fellowship, allowed Cohen to spend two weeks in France, comparing and contrasting the abortion policies and practices of both nations.

Her work comes at a critical time, as the U.S. grapples with the aftermath of the Dobbs decision that overturned Roe v. Wade, while France moves to enshrine abortion rights in its constitution.

Cohen's reporting covered a wide range of angles, including the recent French National Assembly vote to codify abortion rights, access to abortion providers in rural versus urban areas, miscarriage care and ectopic pregnancies, IVF care, medical education and provider access.

Through her stories, she offers unique insights into how two Western democracies approach abortion policy, highlighting the differences in legal frameworks, medical practices and societal attitudes. This How I Did It delves into Cohen's experiences during her reporting trip, the challenges she faced, and the valuable lessons she believes Americans can learn from France's approach to abortion care.

This conversation has been lightly edited for brevity and clarity.

What made you decide to compare abortion policy between the U.S. and France?

I started noticing that Republicans on the Hill, in legal opinions, etc., were pointing to European abortion law as sort of an example that the U.S. should follow because most European countries have a first-trimester abortion limit. I also observed that politicians like Lindsey Graham and Marco Rubio, and even some justices in the Dobbs decision, were referencing European abortion laws as a model for the U.S. This prompted me to investigate how abortion policy actually works in practice in European countries. Up until now, the U.S. and France have been kind of lockstep when it comes to abortion policy. France was having a reckoning after the Dobbs decision, with a movement to enshrine their existing abortion law in the constitution to prevent future curtailing. This created an interesting comparison and dynamic between the two countries' approaches to abortion policy.

How did the fellowship help you pull the pieces together for this series?

AHCJ is amazing. I would not have been able to do this on my own without the fellowship. Despite my own newsroom being supportive, it wouldn't have been able to fund such an extensive international reporting project due to budget constraints and staffing limitations. AHCJ did a great job of preparing us for this trip with a pre-reporting seminar. There were three other fellows, and everyone had a different project going to a different country, and doing something fascinating. We received training on international reporting, including how to handle cultural differences and potential challenges. The fellowship also provided a budget for travel, accommodations and interpreters, which was essential for overcoming language barriers and accessing diverse reporting locations.

What can Americans learn from France's abortion law, which is also political but where doctors ultimately hold the policy decision?

I think it could be really useful - personal opinion here - for lawmakers to take a much clearer look at what is considered at-will abortion versus what is medically necessary abortion. I think it's very interesting that French law clearly defines what those two things are. France's system distinguishes between "at will" abortions - which are available up to 16 weeks - and medically necessary abortions.

After 16 weeks, abortions require two doctors to confirm medical necessity, which can include physical health risks, psychological distress or extreme economic hardship. While abortion is political in France, the politicians consciously made the choice to put the decision in the hands of doctors. This approach gives more autonomy to physicians and hospitals, with less concern about lawsuits. And it's required if you have a conscience objection to performing an abortion that you must refer to a doctor, like, within a certain geographic radius. This requirement helps ensure that even in areas where individual doctors may object to performing abortions, patients can still access care.

You churned out five different stories from this fellowship. What angles did you take?

The National Assembly voted to codify abortion rights in the constitution while I was on my reporting trip in March 2024, which set the tone for my reporting trip to France. I was able to spend the first week just entirely in Paris, which was fantastic because that was the week of the vote. And there was a lot of interest and excitement around what had just happened in Parliament. And I got to speak with a lot of physicians and policy people and advocates.

The second week I was there, I split my time between two other cities in France and took day trips to small towns outside the city. I wrote stories looking at access to abortion providers and availability of OBGYNs in rural versus urban areas, then on miscarriage care and ectopic pregnancies, comparing treatment in France and the U.S. I also looked at IVF care, especially in light of recent U.S. court decisions regarding embryo personhood, medical education and provider access, comparing how medical students in France and the U.S. approach OBGYN care. And there was also an overall story comparing the experiences of physicians in Europe and the U.S., focusing on the American political landscape.

How did you overcome the language barrier when you spoke to Parliament members and clinicians?

AHCJ encouraged us to hire interpreters for certain parts of our trip. We were given a budget for the whole experience and we got to work within that to get from reporting site to reporting site and our airfare. I used interpreters for specific situations, such as when spending a day at a clinic in a rural area talking to patients or when reporting from Parliament.

There were a lot of days where I didn't need an interpreter at all. I also have some basic French language skills, which were helpful for simple interactions but not sufficient for interviews.

But were there also aspects of the reporting that came easier than reporting on U.S. health care?

HIPAA here prevents us as journalists from really interacting with patients in many ways. There, that is not a thing at all. I was in Montpellier and I had set up in the morning to have breakfast with a physician there who does abortion care and leads the reproductive services in this one major hospital in Montpellier. And after we finished coffee, he said, "Oh, I have some surgeries. Would you like to scrub in and take notes?"

It really just gave me a bit of pause because I've been reporting about abortion care and abortion politics for years, but to actually be in the room with patients before they go in - to sort of stand in the background while procedures are happening - it's just a whole new perspective on the gravity of these situations.

It sounds like the time you had in the country allowed for very comprehensive reporting on this aspect of health care, which can be difficult to do in a fast-moving cycle.

To have this opportunity to spend two weeks just focusing on one big storyline and being given the finances and the resources to get it done was such a gift. This fellowship gave me the opportunity to move beyond the statistics and policy to understand the human aspects of abortion policy. I don't know if I'll ever have that opportunity again. I've learned a lot about my beat, and even though French health care policy is not what I cover day-to-day, it really has informed my U. S. reporting.