Abortion is the loss of an embryo or fetus during pregnancy.
It can be spontaneous, that is to say occur without being sought (health problem, genetics, etc.), or provoked and therefore voluntary.
- Spontaneous abortion. We also talk about miscarriage. By definition, it refers to the death or expulsion from the maternal organism of an embryo or fetus of less than 500 grams or less than 22 weeks of amenorrhea or without menstruation (= 20 weeks of pregnancy). If the miscarriage occurs later in the pregnancy, it is called “fetal death in utero”.
- The induced abortion , also called “abortion” (or abortion) can be triggered in several ways, including taking medication “abortifacients” or the aspiration of the fetus. Laws governing access to abortion (or its prohibition) differ from one country to another.
- Medical Termination of Pregnancy (GAM) is a medical induced abortion, often because of a life-threatening abnormality or illness of the fetus after birth or serious health problems, or when the life of the mother is in danger.
Spontaneous abortion: prevalence and causes
Miscarriage is a very common phenomenon. Most of them are related to a genetic or chromosomal abnormality of the embryo, which is then expelled naturally by the mother.
We distinguish :
- early miscarriage occurring during the first trimester of pregnancy (less than 12 weeks of amenorrhea). They affect 15 to 20% of pregnancies but sometimes go unnoticed when they occur in the first few weeks because they are sometimes confused with the rules.
- late miscarriages, occurring during the second trimester, between approximately 12 and 24 weeks of amenorrhea. They occur in about 0.5% of pregnancies around.
- fetal deaths in utero, in the third trimester.
There are many causes that can lead to miscarriage or even repeated miscarriage.
Among these causes, there are in the first place genetic or chromosomal abnormalities of the embryo, involved in 30 to 80% of early miscarriages.
Other possible causes of spontaneous abortion are:
- an abnormality of the uterus (eg, septate uterus, open bite of the cervix, uterine fibroids, uterine synechiae, etc.), or the syndrome DES concerning women who had been exposed in utero to distilbene (born between 1950 and 1977).
- hormonal disorders, which prevent pregnancy from being completed (thyroid disorders, metabolic disorders, etc.).
- multiple pregnancies that increase the risk of miscarriage.
- the occurrence of an infection during pregnancy. Many infectious or parasitic diseases can cause a miscarriage, especially malaria, toxoplasmosis, listeriosis, brucellosis, measles, rubella, mumps, etc.
- some medical examinations, such as amniocentesis or trophoblast biopsy, can cause a miscarriage.
- the presence of an IUD in the uterus at the time of pregnancy.
- Certain environmental factors (consumption of drugs, alcohol, tobacco, drugs …).
- Immune disorders (of the immune system), especially involved in repeated miscarriage.
Induced abortion: state of play
Statistics on induced abortion worldwide
The World Health Organization (WHO) regularly publishes reports on induced abortions around the world. In 2008, about one in five pregnancies would have been interrupted voluntarily.
In total, nearly 44 million abortions were performed in 2008. The rate is higher in developing countries than in industrialized countries (29 abortions per 1,000 women aged 15 to 44 compared with 24 per 1,000). respectively).
According to a study published in 201 , the global abortion rate declined from 35 to 29 per 1,000 women between 1995 and 2003. Today, there are an average of 28 abortions per 1,000 women.
Abortion is not legal everywhere in the world. According to the Center for Reproductive Rights organization , more than 60% of the world’s population lives in countries where abortion is allowed with or without restrictions. About 26% of the population lives instead in states where this act is prohibited (although sometimes allowed if the woman’s life is in danger due to medical reasons).
|WHO estimates that of the approximately 210 million pregnancies that occur each year worldwide (2008 figures), about 80 million of them are unwanted, or 40% .|
Statistics on induced abortion in France and Quebec
In France, in 2011, 222,300 voluntary abortions were completed. This number has been stable since 2006, after a decade of increase between 1995 and 2006. On average, the rate of induced abortion is 15 induced abortions per 1,000 women.
The rate is comparable in Quebec, with about 17 abortions per 1,000 women, or about 27,000 per year.
In Canada, the rates vary between 12 and 17 abortions per year per 1,000 women of childbearing age, according to the provinces (100,000 total abortions reported in 2003).
In both countries, about 30% of pregnancies result in abortions.
In Canada, as in France, voluntary termination of pregnancy is legal. This is also the case in most European countries.
In France, abortion can only be performed before the end of the 12th week of pregnancy (14 weeks of amenorrhea). It’s the same in Belgium and Switzerland, in particular.
As for Canada, it is the only western country where there are no laws that limit or regulate late abortions. According to studies conducted in 2010, abortions after 20 weeks of pregnancy, however, represent less than 1% of abortions in Quebec, or about 100 cases per year.
Who is affected by induced abortions?
Induced abortions affect all age groups in women of childbearing age, and all social groups.
In France and Quebec, the abortion rate is higher among women aged 20 to 24. Four-fifths of the abortions performed there are for women between 20 and 40 years old.
In two thirds of cases, in France, abortions are performed on women who use contraceptives.
Pregnancy occurs due to failure of the method in 19% of cases and incorrect use in 46% of cases. For women taking oral contraceptives, the missed pills are involved in 90% of cases.
In developing countries, more than contraceptive failures, it is mainly the total absence of contraception that leads to unwanted pregnancies.
Possible complications of abortion
According to WHO, a woman dies every 8 minutes in the world because of abortion-related complications.
Of the 44 million abortions performed worldwide each year, half are performed in unsafe conditions, by someone “who does not have the necessary skills or in an environment that does not meet the minimum medical standards.,or both.
There are about 47,000 deaths directly related to these abortions, 5 million women suffering from complications after the act, such as hemorrhages or septicemia.
For example, unsafe abortions are one of the most easily preventable causes of maternal mortality (accounting for 13% of maternal deaths in 2008).
The leading causes of death related to abortions are:
- infections and septicemia
- poisonings (due to consumption of plants or abortion drugs)
- Genital and internal injuries (bowel or perforated uterus).
Non-fatal sequelae include problems with scarring, infertility, urinary or faucal incontinence (related to physical trauma during the procedure), etc.
Almost all illegal or unsafe abortions (97%) are performed in developing countries. The African continent alone accounts for half of the mortality attributable to these abortions.
According to the WHO, “these deaths and disabilities could have been avoided if these induced abortions had been carried out legally and safely, or if their complications had been properly managed upstream, if patients had access to sex education and family planning services. ”
In France and in countries where abortion is practiced in a safe manner, the associated mortality is about three deaths per million abortions, ie a small risk. The main complications are, when the abortion is done by surgery:
- Uterine perforation (from 1 to 4 ‰)
- Tearing of the cervix (less than 1%).
Symptoms of Spontaneous Abortion
Depending on the case, spontaneous abortion may result in:
- cessation of pregnancy without expulsion (often marked by a disappearance or a reduction of signs of pregnancy such as nausea or breast pain);
- The expulsion of the embryo or fetus.
The symptoms are usually:
- Vaginal bleeding more or less abundant. However, bleeding occurring during pregnancy is not systematically related to a miscarriage, far from it.
- Abdominal cramps, stomach pain or lower back.
- Vaginal loss of fluid, blood clots or debris from the uterus.
After an abortion , abdominal cramps and bleeding may occur with varying intensity for a few days. The symptoms associated with pregnancy gradually disappear as the amount of pregnancy hormones decreases in the blood.
Risk Factors for Spontaneous Abortion
In the first trimester of pregnancy, early miscarriages are frequent and should not worry too much. The vast majority of these are sporadic events that correspond to a natural process of elimination of non-viable embryos. Having a single miscarriage does not increase the risk of experiencing other miscarriages in subsequent pregnancies.
For about 1 to 2% of couples wanting a child, however, miscarriages occur repeatedly (at least three spontaneously interrupted pregnancies before 12 weeks of pregnancy, by definition).
The higher the number of miscarriages, the greater the risk of subsequent pregnancies. Thus, this risk is:
- 17 to 35% after 2 spontaneous miscarriages
- 25 to 46% after 3 miscarriages
- More than 50% after 6 miscarriages .
Factors that may increase the risk of natural miscarriage are:
- age (35 years old and over)
- Health problems (infections, blood clotting problems, endocrine diseases, autoimmune, uterine or ovarian problems, etc.)
- The consumption of alcohol, drugs or tobacco.
- exposure to certain chemicals, such as pesticides for example
- taking certain medicines or medicinal herbs
Risk factors for abortion
Although abortions affect all women of all ages and social classes, some factors are associated with an increased risk of abortion:
- the lack of easy access to contraception
- the lack of sex education programs
the fact of having already undergone an abortion, which is a risk factor to have it a second time, or several other times.