Agnès Guillaume

Representations and uses of emergency contraception in West Africa : a social anthropological reading of a northern medicinal product

Since the early 2000s a new form of progesterone based emergency contraception with no side effects has been on the African market, aimed at reducing contraceptive failure rates and the mortality associated with the practice of unsafe abortion. Studies of emergency contraception (EC) carried out in West Africa have only examined opinions and knowledge about EC. We hypothesized that representations and uses of this method takes place at the intersection of two dimensions: (i) a Northern pharmaceutical norm, and (ii) local understandings of the timing of conception. To test this hypothesis we used a discourse analysis of semi-structured interviews with 149 women and 77 with men aged between 18 and 40, of varying marital, social and professional status, resident in Dakar, Ouagadougou and Accra. The interviews were conducted in 2005-2007. EC is overwhelmingly perceived as a Northern medical treatment which encourages greater sexual freedom for women. Many respondents, both male and female, believe that EC is a chemical product that may cause sterility, and there is severe questioning of its supposed abortifacient character. EC is being used as recommended by the medical profession - in an occasional manner and in cases of urgent need; but it is also being used, like other post-coital methods which women have long employed, in a programmed and repeated manner. On the one hand the social issue raised by EC, namely the weakening of control by men of the sexuality and fertility of women, may be an obstacle to its diffusion. On the other hand, it may in the end be viewed as simply another post-coital method, whose use is framed by the prevailing systems of temporal representations in the three countries concerned in the study.

The Role of Abortion in the Fertility Transition in Abidjan (Côte d'Ivoire) during the 1990s

A l’image de nombreux pays africains, la Cote d’Ivoire est entree dans une phase de transition de la fecondite particulierement marquee en milieu urbain. Ces changements se produisent dans un contexte de faible prevalence contraceptive, soulevant la question du role des autres determinants de la baisse de la fecondite, en particulier l’avortement.Une etude realisee a Abidjan aupres de femmes qui consultent dans des centres de sante a permis d’analyser en detail les modes de regulation de la fecondite et les relations entre avortement et fecondite. L’avortement est une pratique de plus en plus frequente, malgre son illegalite, notamment chez les jeunes femmes et des le debut de la vie feconde. Contraception et avortement sont parfois utilises de facon complementaire, l’avortement intervenant en cas d’echec de la contraception (en particulier d’une methode naturelle). Dans certains cas, il semble que l’experience d’un avortement entraine le recours a des methodes efficaces, bien que cela ne soit pas systematique. Les donnees presentees ici montrent qu’il n’est pas possible de comprendre la baisse de la fecondite a Abidjan sans prendre en compte le role majeur des pratiques abortives.

Le rôle de l'avortement dans la transition de la fécondité à Abidjan au cours des années 1990

Like many African countries, Cote d?Ivoire has entered a phase of fertility transition which is particularly pronounced in urban areas. These changes are occurring in a context of low contraceptive prevalence, raising the question of the contribution of other determinants, particularly abortion, to the fertility decline. A study conducted in Abidjan on women consulting at health centres has been used to make a detailed analysis of the methods of fertility regulation and of the link between abortion and fertility. Despite being illegal, the practice of abortion is increasingly common, particularly among young women and from the beginning of reproductive life. Contraception and abortion are sometimes complementary, with abortion being resorted to following contraceptive failure (particularly of natural methods). In some cases it seems that the experience of an abortion leads to adoption of effective methods, although this is not systematic. The data presented here show that fertility decline in Abidjan cannot be understood without taking into account the major contribution of abortion practices.