CHRONIQUE DU Dr Cheick Atab BADJI
Si dans le douloureux cas des grossesses non désirées, l' »avortement médicalisé » est préconisé par une certains acteurs sociaux, force est de reconnaitre que cette solution n’est pas sans problèmes. D’une problématique qui tient à la fois d’un flou conceptuel et d’une difficulté opérationnelle et technique certaine.
Le contexte législatif
Dans l’architecture lexicale actuelle, du point de vue de la légalité, l’avortement se présente sous trois formes: l’avortement spontané (AS) ou fausse couche spontanée (FCS), l’interruption thérapeutique de grossesse (ITG) et l’avortement provoqué clandestin (APC). Dans le premier cas, il s’agit d’une grossesse qui s’arrête d’elle-même ou du fait d’un facteur indépendant et involontaire comme certaines maladies abortives comme le paludisme et toutes les causes de fièvre. Face à ces situations précises, il ya des protocoles de prise en charge définis dans les normes et protocoles ministériels appelés SOINS APRES AVORTEMENT. Par ailleurs, le seul cas actuellement autorisé par les textes législatifs, c’est l’ ITG. Il s’agit des situations cliniques où le médecin dépiste chez la femme une maladie grave, incompatible avec la grossesse au prix de mettre en péril la vie de la gestante, notamment en présence de certaines pathologies sévères du cœur, du cancer… Ici il est important de préciser que c’est bien le médecin qui pose le diagnostic qui est l’objet d’une confrontation et le reste du processus est bien encadré. Par contre, toutes les manœuvres visant à interrompre la grossesse relèvent de l’avortement provoqué clandestin (APC). Ailleurs où il est légalement admis, on parle d’interruption volontaire de grossesse (IVG). Ici, on le qualifie de clandestin parce que réprimé par la loi quelque soit l’agent (médecin, sage femme ou pas), le lieu (structure de soins ou pas), le motif outre que ceux-ci-dessus mentionnés, et l’âge de la grossesse. Cependant et fort malheureusement, le taux relativement élevé de grossesses non désirées (malgré les méthodes contraceptives) et le poids socio-religieux vont de pair avec un recours croissant à cette pratique exposant ainsi à une pénalisation accrue. Ainsi posée, la question de l’avortement ou plutôt de droit à l’avortement reste une question de droit et de société dans ses valeurs intrinsèques et ses aspirations légitimes par rapport au modèle qui est le sien. Mais placé sous le vocable médical, comme surement porte d’entrée de communication, il doit obligatoirement susciter un débat technique qui transcende les arguments émotionnels.
Avortement médicalisé : un concept flou
La notion d' »avortement médicalisé » est un concept flou qui n’a pas encore une définition opérationnelle claire, ce qui expose à un risque de mise en œuvre socialement désastreuse. En effet, nul se sait si « avortement médicalisé » veut dire avortement pratiqué par un gynécologue, un médecin (s’il est logiquement considéré comme un acte médical), une sage femme ou un infirmier, dans une structure de santé et de quel type, à quelque moment et selon quel protocole, entre autres. Bref il s’agit d’un concept vague très flou dans la tête de ses propres défenseurs et un argumentaire médical qui souffre d’une légèreté et un manque de sérieux scientifique. Ce qui trahit juste une injuste volonté de manipulation des esprits. En effet, la corrélation avec la mortalité maternelle dans des versions anecdotiques et macabres ne relève que de la farce noire.
VIOL ET INCESTE
Là encore, s’il faut certes comprendre tout le travail des activistes pour la légalisation des avortements post viols et incestes, il importe de souligner qu’il ne suffit pas juste de légaliser. Il faudra impérativement mettre en place des structures chargées exprès de ces questions sinon beaucoup de demandes resteront sans offre car nos structures sanitaires ne sont pas habituées à ce genre de demande de prise en charge. Déjà y obtenir un certificat médical complet n’est pas toujours facile parce que l’interrogatoire dans ce contexte est souvent délicat et nécessite une intimité, une patience, une mise en confiance que les services d’urgence ne prêtent pas toujours, faute de cadre adapté et de surcharge de travail. En plus, la question de la clause de conscience tenant compte des convictions morales et religieuses des praticiens reste entière. Et même quand l’avortement sera autorisé pour ces cas de viol se posera la lancinante question de celui qui va poser le diagnostic. En effet jusqu’à ce jour, le seul cas où l’avortement thérapeutique est légalement autorisé, c’est quand la vie de la femme est en danger. Là c’est au médecin de porter le diagnostic. Par contre, le diagnostic de viol, encore moins d’inceste sera plus juridique que médical. Dans ces cas précis (et comme dans les cas d’autopsie du reste), le certificat médical établit plus la causalité que l’imputabilité. D’où l’intérêt d’approfondir sérieusement la réflexion, car la question de l’avortement dit « médicalisé » est moralement, socialement et médicalement … tout simplement sérieuse.
Dr Cheick Atab BADJI
Gynécologue-Obstétricien/ Obst-Gyn
Master en Management de Projets/Projects Manager
Master (c) en santé publique, Suivi et Evaluation de programmes et projets de santé/ MPH Health Projects and Programs Monitoring and Evaluation
Lauréat en Promotion de la Santé/Health Promotion
MBA en Science Politique, Géostratégie et Relations Internationales/ Political Science, Geostrategy and International Relationship
Analyste de politique, offre politique, biopolitique et Géostratégie de la santé mondiale/ Policy, biopolitic and Global Health Geostrategy analyst
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