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Face aux grossesses non désirées et à leurs conséquences sanitaires, l’avortement médicamenteux, par le biais du misoprostol, apparaît comme une porte de sortie. En Afrique, où la législation de l’avortement est la plus restrictive, il est moins développé qu’ailleurs. L’utilisation du misoprostol y est peu documentée, notamment dans les pays francophones. Notre étude qualitative, menée à Cotonou et à Ouagadougou, décrit les réalités actuelles entourant les relations affectives et la sexualité, en lien avec l’avortement et les moyens concrets mis en place dans ce but. Nous soulignons tout d’abord le décalage entre des pratiques sexuelles dissociées des questions reproductives et des recommandations sociales largement centrées sur cette association. Puis, nous mettons en évidence des pratiques d’avortement fort différentes dans les deux pays, parmi lesquelles l’avortement médicamenteux, bien que minoritaire, semble se développer. When faced with unwanted pregnancies and their sanitary consequences, medical abortion with misoprostol, appears as an exit. In Africa, where legislation towards abortion is the most restrictive, this practice is less developed than elsewhere. The use of misoprostol, particularly in French-speaking countries, is little documented. This qualitative study, led in Cotonou and Ouagadougou, describes current realities surrounding emotional relations and sexuality, in link with abortion and concrete modes set up for this purpose. We first underline the gap between sexual practices disconnected from reproductive questions and social recommendations widely focused on this association. Then we highlight very different abortion practices in the two countries, among which medical abortion, although in minority, seems to be developing.

Objectives This study aimed to document the means women use to obtain abortions in the capital cities of Benin and Burkina Faso, and to learn whether or not use of misoprostol has become an alternative to other methods of abortion, and the implications for future practice. Study design We conducted in-depth, qualitative interviews between 2014 and 2015 with 34 women – 21 women in Cotonou (Benin) and 13 women in Ouagadougou (Burkina Faso) – about their pathways to abortion. To obtain a diverse sample in terms of socio-demographic characteristics, we recruited the women through our own knowledge networks, in health facilities where women are treated for unsafe abortion complications, and in schools in Benin. Results The 34 women had had 69 abortions between them. Twenty-five of the women had had 37 abortions in the previous 5 years; the other abortions were 5–20 years before. Pathways to abortion were very different in the two cities. Lengthy and difficult pathways with unsafe methods often led to complications in Ougadougou, whereas most Cotonou women went to small, private health centers. Six of the 37 abortions in the previous 5 years involved misoprostol use, and were all among educated women with significant social and economic capital and personal contact with clinicians. Conclusions Use of misoprostol for abortion has appeared in both Cotonou and Ougadougou in the past 5 years. Evidence that the use of misoprostol for abortion occurred among women with the most access to information and resources in this study suggests that increased awareness of and use of misoprostol in both countries is likely in the coming years. Implications Although no pharmaceutical company that produces misoprostol has as yet tried to obtain marketing authorization in either Burkina Faso or Benin for gynecological-obstetric indications, making its use more potential than actual for the time being, international advocacy for access to medical abortion is growing rapidly and is likely to lead to many changes in this picture in the coming years.

Face aux grossesses non désirées et à leurs conséquences sanitaires, l'avortement médicamenteux, par le biais du misoprostol, apparaît comme une porte de sortie. En Afrique, où la législation de l'avortement est la plus restrictive, il est moins développé qu'ailleurs. L'utilisation du misoprostol y est peu documentée, notamment dans les pays francophones. Notre étude qualitative, menée à Cotonou et à Ouagadougou, décrit les réalités actuelles entourant les relations affectives et la sexualité, en lien avec l'avortement et les moyens concrets mis en place dans ce but. Nous soulignons tout d'abord le décalage entre des pratiques sexuelles dissociées des questions reproductives et des recommandations sociales largement centrées sur cette association. Puis, nous mettons en évidence des pratiques d'avortement fort différentes dans les deux pays, parmi lesquelles l'avortement médicamenteux, bien que minoritaire, semble se développer.