In the United States, the fight surrounding reproductive rights centers on abortion, but in France—a country Americans often think of as socially progressive and sexually liberated—the debate is about who should be allowed or encouraged to conceive.

Under French law, only heterosexual couples who are married or have been living together for at least two years have access to medically assisted reproduction, like sperm donation or IVF treatments. That may be changing soon. On October 15, the lower house of France’s Parliament voted overwhelmingly in favor of a bioethics bill that would make medically assisted reproduction available to all women under the age of 43, regardless of marital status or sexual orientation. This bill marks President Emmanuel Macron’s first major social reform since taking office in 2017. Before it can become law, though, it needs to pass through the Senate, which has a right-wing majority. The bill, which is currently under discussion, will go to a vote in January.

“This is about what society we want to live in and offer future generations,” Macron’s health minister, Agnès Buzyn, said in October when she presented the bill to the National Assembly. “Same-sex parents and single parents exist today, that’s a fact, and it would be hypocritical not to see them and not to recognize them.”

Because the state heavily subsidizes health care and provides financial assistance for families with children, this is a debate not just about individual rights but also about the family. Right now, the French government will pay for six rounds of artificial insemination and four rounds of IVF for long-term heterosexual couples. A doctor found to be providing artificial insemination or IVF to a single woman or lesbian couple can be punished with up to two years in prison and a €30,000 fine.

Single women and lesbian couples who want to conceive have a range of black market options. Some women travel to nearby countries—such as the UK, Spain, Belgium, or the Netherlands—for treatment, which can be very expensive. Gwendoline Desarménien paid about $6,600 for one round of IVF treatment in Spain. This was a significant expense for her, but as a 39-year-old single, lesbian woman who wanted to have a baby, it was her only option, and she could afford only one round of treatment. “It’s difficult to tell yourself that because the French government won’t let you do it, you have to go to another country, you have to pay for it, and maybe your dream will never come true,” Desarménien told me. She was fortunate: Her treatment worked, and her daughter is now 20 months old.

Many women who cannot afford to go abroad turn to online networks, such as Co-parents.fr and Donneur Naturel, where women seeking sperm donors can post profiles and connect with potential donors.

Not all of the men volunteering their services on these unregulated networks are in it for altruistic reasons. Some request money (remuneration is illegal for sperm donation in France), while others insist on providing their donation though “natural insemination.” In other words, sex. A France24 reporter set up an account on one of the networks and found that many of their male correspondents insisted on “natural insemination.”

Another risk of using black market donor networks concerns the lack of screening and oversight. While donors with France’s official sperm bank must undergo extensive vetting and medical testing for STIs and communicable diseases, women using black market sperm are forced to take the donors at their word. They must also contend with the possibility that the donor might decide to claim fatherhood, or even custody. In the case of lesbian couples, the sperm donor retains more parental rights than the non-birthing mother, who must complete lengthy and complicated paperwork in order to formally adopt the child.

The ethics board of France’s National Academy of Medicine recently published a report warning that “the deliberate conception of a child depriving it of a father constitutes a major anthropological break that is not without risk for the psychological development and well-being of the child.” The National Academy of Medicine is a nonpartisan organization, but this warning aligns with the arguments of the bill’s right-wing opponents. “That is something I have been hearing for a long, long time. That children have to have a mom and a dad,” Desarménien said. “And I don’t agree. A child needs to have parents that love him, that raise him with values, with love.”

The current debate, therefore, is not just about reproductive rights; it is a fundamental challenge to the heteronormative and patriarchal conception of the family unit.

On October 6, an estimated 42,000 people gathered in Paris to protest the bioethics bill. The protesters were a blend of Conservative Catholics and right-wing activists. As they marched through the city, many chanted “Liberty, Equality, Paternity,” in a play on the French motto. The protesters’ invocation of this traditional symbol speaks to the their conception of the bill as a challenge to what they perceive as a foundational element of the French republic.

Gay marriage was legalized in France in 2013, and many view this bill as a natural continuation: If gay people can marry, they should also be allowed to start a family. Adoption by gay couples has been legal since 2013, but it remains very difficult for gay couples to adopt, thanks to complicated bureaucratic obstacles. The legalization of gay marriage sparked months of violent protests in the streets of Paris. The same organizations who sponsored those protests are behind the current demonstrations, but public opinion appears to be turning against them. A recent poll reports that 63 percent of the French population supports medically assisted reproduction for all.

Others have voiced concerns about different aspects of the bioethics bill. In addition to giving all women access to medically assisted reproduction, the bill would abolish anonymity for sperm donors. CECOS, France’s network of public sperm banks, predicts that abolishing donor anonymity could prompt up to 75 percent of currently registered donors to deny clinics the use of their sperm and eggs. “To say ‘everything is going to be OK’ would be burying your head in the sand,” Nathalie Rives, president of the CECOS federation, told Reuters. “There will be a period of instability, with increased demand and the need to recruit new donors. We don’t know how long this instability will last and whether there will be a shortage.”

De-anonymization of sperm donors is part of a global trend. Many European countries do not allow anonymous donation. In the United States, sperm donation regulations vary by clinic; there is no federal law on the matter. California Cryobank, which is the largest American network of sperm banks, recently announced that it will no longer accept anonymous donations. A 2016 US study found that the impact of revoking anonymity might be remedied by offering increased remuneration to donors. This, however, is not an option in France, where politicians on both sides of the aisle are concerned with the commercialization of the body.

Desarménien acknowledged that issues such as sperm supply will need to be addressed. Still, she remains optimistic about the bill and the progress it represents. “We have to move on. We are an old-fashioned country sometimes. It is possible in Spain, in Belgium, in the Netherlands, in England, and it has to pass in France,” she said. “I didn’t make the choice to be single, I didn’t make the choice to be homosexual. It is like that. And I have the right to be a mom.”