Abortion is the loss of an embryo or fetus during pregnancy.

It can be spontaneous, that is to say occur without having been researched (health problem, genetics, etc.), or provoked and therefore voluntary.

• Spontaneous abortion. We also talk about miscarriage. By definition, it is the death or expulsion from the maternal body of an embryo or fetus weighing less than 500 grams or less than 22 weeks of amenorrhea or without menstruation (= 20 weeks of pregnancy). If the miscarriage occurs later in pregnancy, it is called “fetal death in utero”.

• THEinduced abortion, also called “voluntary termination of pregnancy” (or abortion) can be triggered in several ways, in particular by taking “abortive” drugs or by aspiration of the fetus. Laws governing access to (or prohibition of) abortion differ from country to country.

• Medical termination of pregnancy (IMG) is an induced abortion, performed for medical reasons, often because of an abnormality or disease of the fetus which is life-threatening after birth or causes serious health problems, or when the life of the fetus the mother is in danger.

Spontaneous abortion: prevalence and causes

Miscarriages are a very common occurrence. They are, for the most part, linked to a genetic or chromosomal anomaly in the embryo, which is then expelled naturally by the mother.

On distingue :

• early miscarriages, occurring during the first trimester of pregnancy (less than 12 weeks of gestation). They affect 15 to 20% of pregnancies but sometimes go unnoticed when they occur in the very first weeks because they are sometimes confused with the rules.
• late miscarriages, occurring during the second trimester, between about 12 and 24 weeks of gestation. They occur in about 0,5% of pregnancies¹.
• fetal death in utero, in the third trimester.

There are many, many causes that can lead to miscarriage or even repeated miscarriages.

Among these causes, we find in the first place genetic or chromosomal abnormalities of the embryo, involved in 30 to 80% of early miscarriages.².

Other possible causes of spontaneous abortion are:

• an abnormality of the uterus (eg partitioned uterus, open cervix, uterine fibroids, uterine synechiae, etc.), or DES syndrome in women who have been exposed in utero to distilbene (born between 1950 and 1977).
• hormonal disorders, which prevent the pregnancy from being carried to term (thyroid disorders, metabolic disorders, etc.).
• multiple pregnancies which increase the risk of miscarriages.
• the occurrence of infection during pregnancy. Many infectious or parasitic diseases can indeed cause miscarriage, in particular malaria, toxoplasmosis, listeriosis, brucellosis, measles, rubella, mumps, etc.
• some medical tests, such as amniocentesis or trophoblast biopsy, can cause a miscarriage.
• the presence of an IUD in the uterus during pregnancy.
• Certain environmental factors (consumption of drugs, alcohol, tobacco, medication, etc.).
• Immunological disorders (of the immune system), especially involved in repeated miscarriages.

Induced abortion: inventory

Statistics on induced abortion around the world

The World Health Organization (WHO) regularly publishes reports on induced abortions around the world. In 2008, approximately one in five pregnancies would have been interrupted on purpose.

In total, nearly 44 million abortions were performed in 2008. The rate is higher in developing countries than in industrialized countries (29 abortions per 1000 women aged 15 to 44 compared to 24 per 1000, respectively).

According to a study published in 2012³, the global abortion rate fell from 35 to 29 per 1000 women between 1995 and 2003. Today, there are an average of 28 abortions per 1000 women.

Abortion is not legalized everywhere in the world. According to the organization Center for reproductive rights, more than 60% of the world’s population live in countries where abortion is permitted with or without restrictions. On the contrary, about 26% of the population lives in states where this act is prohibited (although it is sometimes authorized if the woman’s life is in danger for medical reasons)⁴.

Statistics on induced abortion in France and Quebec

In France, in 2011, 222 voluntary terminations of pregnancy were carried out. This number has been stable since 300, after ten years of increase between 2006 and 1995. On average, the rate of abortion is 2006 induced abortions per 15 women.⁶.

The rate is comparable in Quebec, with approximately 17 abortions per 1000 women, or approximately 27 per year.

In Canada, rates vary between 12 and 17 abortions per year per 1 women of reproductive age, depending on the province (000 total abortions reported in 100)⁷.

In these two countries, about 30% of pregnancies result in abortion.

In Canada as in France, the 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 is the same in Belgium and Switzerland, in particular.

As for Canada, it is the only western country where there are no laws limiting or regulating late abortions.⁷. According to studies carried out in 2010, abortions after 20 weeks of pregnancy however represent less than 1% of abortions in Quebec, or about a hundred cases per year.

Who is affected by induced abortions?

Induced abortions affect all age groups among women of childbearing age, and all social backgrounds.

In France and Quebec, the abortion rate is higher among women aged 20 to 24. Four-fifths of abortions performed there concern women between 20 and 40 years old.

In two thirds of cases, in France, abortions are performed in women who use a contraceptive method.

Pregnancy occurs due to method failure in 19% of cases and due to its incorrect use in 46% of cases. For women on oral contraception, forgetting the pill is involved in more than 90% of cases⁸.

In developing countries, more than contraceptive failures, it is above all the total lack of contraception that leads to unwanted pregnancies.

Possible complications of abortion

According to the WHO, a woman dies every 8 minutes worldwide due to complications from an abortion.

Of the 44 million abortions performed each year worldwide, half are performed in unsafe conditions, by a person “who does not have the necessary skills or in an environment that does not meet minimum medical standards. , or both “.

We deplore about 47 deaths directly linked to these abortions, 000 million women suffering from complications after the act, such as hemorrhages or septicemia.

Thus, unsafe abortions are one of the most easily preventable causes of maternal mortality (they were responsible for 13% of maternal deaths in 2008)⁹.

The main causes of death related to abortions are:

• hemorrhages
• infections and sepsis
• poisoning (due to the consumption of plants or abortive drugs)
• genital and internal injuries (perforated intestine or uterus).

Non-fatal sequelae include healing problems, infertility, urinary or fecal incontinence (related to physical trauma during the procedure), etc.

Almost all clandestine 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 performed within a legal framework and in good safety conditions, or if their complications had been properly taken care of upstream, if the patients had access to sexuality education and family planning services ”.

In France and in countries where abortion is performed safely, the associated mortality is around three deaths for a million abortions, which is a very low risk. The main complications are, when the abortion is done by surgery:

• uterine perforation (1 to 4 ‰)
• a tear in the cervix (less than 1%)¹⁰.