DA Grimes, J Benson, S Singh, M Romero

Avortement à risque 

d’après: « Unsafe abortion: 

the preventable pandemic » 

DA Grimes, J Benson, S Singh, M Romero, 

B Ganatra, FE Okonofua, IH Shah 

Lancet 2006; 368: 1908–19; Published Online, Nov 1, 2006 © 

IFMT-MS.Sémin.Mère- 

Enft.déc.2006 

1

Avortement à risque : définition 

• Procédure qui vise à interrompre une grossesse 

• Il s’agit d’une grossesse non désirée 

• La procédure est pratiquée par : 

– un personnel non qualifié, souvent la femme elle même 

– ou un professionnel, mais dans un environnement à risque : 

instruments non stériles, absence d’hygiène et moyens techniques 

élémentaires 



2

Avortement à risque : définition 

• Fréquence très sous estimée par les statistiques de santé 

(en Inde par ex.: 10-25% des femmes seraient concernées) 

• L’Impact de l’avortement à risque est majeur aux plans 

– psychologique 

– sanitaire : morbidité / mortalité non négligeables 

–social: contexte d’ignorance, solitude, pauvreté 

– juridique : dans certains pays ou l’avortement est jugé criminel 



3

UA, world perspective 



4

Avortements 

non médicaux 

répartition 

mondiale 

lois pro / anti-avortement: 

effets sur natalité et sur 

mortalité maternelle 



5



6

Avortements non médicaux 

et décès maternels 

Causes de décès maternels : 

rôle de l’avortement non médical 



7

Unsafe Abortion Methods 

1.Treatments taken by mouth 

Toxic solutions 

• Turpentine 

• Laundry bleach, bluing, detergent solutions 

• Acid 

• Cottonseed oil 

• Arak (a strong liquor) 

• Teas and herbal remedies, strong tea 

• Tea with apio, avocado bark, ginger, etc 

• Tea made of livestock manure 

• Assorted herbal medications 

• Boiled and ground avocado or basil leaves 

• Wine boiled with raisins and cinnamon 

• Black beer boiled with soap, oregano, and 

parsley 

• Boiled apio (celery plant) water with aspirin 

• “Bitter concoction” 



Drugs 

• Uterine stimulants, such as misoprostol 

or oxytocin (used in obstetrics) 

• Quinine and chloroquine (used for malaria) 

• Oral contraceptives (ineffective for abortion) 

2. Intramuscular injections 

• Two cholera immunisations 

• And many others…. 

8

Unsafe Abortion Methods (contin.) 

3. Foreign bodies inserted into the cervix 

4. Inserted in the vagina or cervix 

• woodden stick, sometimes dipped in oil 

• hard green bean, plant root, or leaf 

• piece of sugar 

•metallic : knitting needle , wire, coat hanger , 

bicycle spoke 

• rubber catheter 

• intrauterine contraceptive device 

• ballpoint pen 

• chicken bone 

• air blown in by a syringe 

• Potassium permanganate tablets 

• Herbal preparations 

• Misoprostol 

5. Enemas (intra vaginal-cervical) 

• Soap 

• Shih tea (wormwood) 

6. Trauma 

• Abdominal or back massage 

• Lifting heavy weights 

• Jumping from top of stairs or roof 



9

1. hémorragie 

2. sepsis, choc 

3. péritonite, gangrène 

Complications 

pouvant nécessiter 

hystérectomie 

4. traumatisme col, vagin, utérus, organes abdominaux 

5. Infection génitale haute et stérilité (20-40%) 

6. intoxication aigue 

Ces complications sont fréquentes : 20-50% des femmes doivent être 

hospitalisées pour complication après avortt 

le risque augmente avec l’âge de la grossesse 

(après le 1er trimestre) 

et avec le caractère invasif (intra-utérin) de la procédure 



10

Complications : mécanismes 

1. Rétention placenta (avortt incomplet) hémorragie 

2. Abortifs chimiques (quinine, chloroquine..) Intoxication aigue 

3. Infections systémiques : tétanos, 

Clostridium perfringens, BGN 

sepsis, choc, décès 

4. Perforation d’organes creux péritonite, gangrène 

5. Infection loco régionale 

1. endométrite synéchies utérus, stérilité 

2. péritonite 

6. Injection / insufflation (air, savon) embolie gazeuse 

7. corps étranger local ulcère, nécrose, fistule 



11

Quelles sont les procédures « safe » ? 

1. Méthode médicale : prostaglandines 

1. mifepristone 

2. misoprostol (cytotec ©) 

2. Aspiration 



12

Aspiration 

Prostaglandines 

(vaccum abortion) 

Medical Non-Surgical Abortion 

Buy Mifepristone , Mifegyne , RU 486 online 



13

Medical abortion by Misoprostol (MO) (Cytotec*) 

in Brazil 

• MO (prostaglandin) introduced in Brazil in 1986, rapidlly became available over the counter 

• Women recognised its ective abortifacient properties and began to use the drug 

• They self-administer the drug orally; seeking medic assistance in case of uterine bleeding 

• By 1990, 70% of women treated in hospital for abortion complications in reported use of 

MO. This led the MoHof Brazil to restrict its sale in 1991. Some states banned the drug. 

• However, restricting did not prevent the use : MO remained available at higher prices on 

the black market. Consequently, in some states of Brazil, abortion complications increased 

and abortion-related deaths tripled after MO restriction. 

• MO globally the severity of UA complications, and the hospital admissions: previously, 

foreign bodies inserted into the cervix, caused bleeding urging curettage & infection 

• The wide use of MO for abortion has been associated with improved health for women. 

• Women have widely accepted medical abortion because of it is similar to spontaneous 

abortion. 



14

Images 

(diffusées par les pro et les anti-avortements) 



15

Illegal abortion laws: prosecution in El Salvador 

• “After I came out of the coma, they moved me to the maternity hospital. My brother 

visited and asked me if the police had come to ask me questions. He said the police 

had come to our house and they had interrogated our relatives and neighbours. They 

had gone to where I worked. They asked everyone a lot of questions about me and who 

I was and if they knew whether I was pregnant and whether I’d had an abortion. 

• When I got home, the prosecutor came to see me, and he asked lots of aggressive 

questions. He talked to me like I was a criminal. I didn’t want to answer because I was 

scared. He said if I didn’t answer, even though I was in bad physical shape, he would 

put me in jail. 

• He wanted me to tell him who the father of the child was and the name of the person 

who had done this to me. 

• I didn’t know her name. Then he made a date for me to come to the prosecutor’s office.” 

Anonymous woman in El Salvador 



16

Abortion: A Buddhist Perspective 

Early Scriptures of Buddhism (the Pali canon) see human life as starting with conception. 

If life begins at conception, then any termination following this is seen to be morally 

unwholesome.To have an abortion is to break the first precept - « abstain from harming or 

killing livings beings ». This carries negative karmic consequences which will bear fruit either 

in this life or future lives. 

It is also to deny the precious opportunity that human life affords for the attainment of enlightenment. 

Out of the six realms that make upBuddhist wheel of life, the human realm is seen to be the 

most precious. 

The basic position taken by Buddhism, therefore, is that abortion is wrong. 

But is it ever permissible? 

Exceptions? Buddhism recognises an abortion might be necessary - when the mother's life is at 

risk, for example. This seems to imply that the mother's life is of greater value than the 

embryo or fetus. If this is the case, it might be argued that it is less serious to terminate a less 

developed being than a more developed one. 

A Buddhist might argue that it is morally worse to kill a dog than an ant,or a holy person than a 

murderer. On this basis, is it morally worse to abort a three month old fetus than one at two 

months? 



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Abortion: A Buddhist Perspective (suite) 

Shades of Opinion 

Individual Buddhists may differ in how they assess to what extent abortion is wrong in individual 

cases. 

One stance is that abortion at any stage in the pregnancy is wrong. 

Another stance might be that the offence is worse the more developed the fetus or embryo. 

Yet another might be that the seriousness of the offence can only be determined by taking into 

account the full circumstances surrounding the abortion.For example,would it be more morally 

reprehensible to have an abortion for personnal convenience than for the threat on mother health 

or family wellbeing ? 

The degree of moral culpability is always going to bedifficult to measure 



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Conclusions 

1. 19–20 million avortements à risque (AAR) sont pratiqués / an, 

97% dans les PED (estim.) 

2. 68 000 femmes meurent chaque année, et des millions ont des 

séquelles définitives (estim) 

3. En dépit de cette fréquence l’AAR, est l’un des aspects de la santé 

publique les plus négligés et les plus difficiles à aborder 

4. Causes des décès : hémorragie, infection, et intoxication aux abortifs 

5. L’accès à la contraception moderne peut réduire mais pas éliminer l’AAR 

6. La légalisation de l’A est nécessaire mais pas suffisante à éliminer l’AAR 



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Conclusions (2) 

7. La santé des femmes progresse quant l’A est légal, sûr, accessible; 

à inverse, elle se détériore lorsque l’accès est mauvais ou l’A illégal 

8. En pays développés, l’A légal est très sûr : < 1 décès / 100 000 A. 

9. L’A par aspiration non invasive (manuelle) du contenu utérin, ou par 

médicaments (mifepristone / misoprostol) ont considérablement 

réduit les complications 

10. en PED, traiter ces complications surcharge fortement des services 

de santé déjà pauvres, au détriment d’autres maladies curables 

11. La cause fondamentale de cette pandémie globale est la paresse, et 

le dédain vis à vis des femmes; celles ci souffrent et meurent parce 

qu’elles ne sont pas valorisées. 



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DA Grimes, J Benson, S Singh, M Romero

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