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Incidence and consequences of unsafe abortion and knowledge of /access to SRHR for rural women and girls in Ngoketunjia Division, North West Region of Cameroon

 

Main objective

This research sought to understand the incidence and consequences of unsafe abortion as well as assess the knowledge and access to sexual and reproductive health (SRH) services for rural women and girls in Ngoketunjia Division in Cameroon.

 Executive Summary

“Our daughter is dumb and cannot talk. One day, she went to a neighbour’s house to watch the TV and was raped by the neighbour. Since she could not talk, she came out very furious, but we failed to understand what had happened because the neighbour played normal and claimed as wondering why her mood was different. After three months, we found that she was pregnant and as the mother I was devastated and wanted the baby aborted. We went to the hospital and were told that abortion is not legal in the country except in the case of rape and grave danger on the woman’s life. As we began to find out how the pregnancy came about, we understood that the neighbour had been raping our daughter on multiple counts. However, the doctor said rape could not be determined medically because it is long ago (even if it were ascertained that she was raped). There she is, struggling with the baby” (Interview with an anonymous source on 22.12.2019).

Unsafe abortion account for up to 13% of maternal mortality worldwide [16], and in Cameroon, 40% of women aged 20 years and above tend to have had at-least 2 abortions [15]. Abortion as defined in Cameroon is the termination of pregnancy before 28 gestational weeks either spontaneously, for therapeutic reasons or induced [14]. Induced abortion is legally allowed only when a woman’s life is at risk, to preserve her physical and mental health, and on grounds of rape or incest [13]. However, women may have other reasons for desiring an abortion which are not related to health or rape. Even in the context of rape, the law requires approval by a magistrate which is a complex uphill for women seeking safe abortion services. Despite these restrictive laws as well as the ‘perceived immorality’ of voluntary induced abortion in Cameroon, many Cameroonian women terminate unwanted pregnancies. “Roughly 40% of all pregnancies in the country are unintended, and 36% of these unintended pregnancies end in abortion” [11]. Unsafe abortion identified as one of the leading causes of maternal mortality in Cameroon has stirred ongoing debates on the liberalization of abortion in Cameroon [12]

This research sought to understand the incidence of unsafe abortion, access and availability of SRH services and the drivers, complications/consequences of unsafe abortion in Ngoketunjia division, North West Region of Cameroon. Quantitative data were collected by questionnaire administration to women and girls of the 13 villages that make up Ngoketunjia Division. Qualitative data was also collected using in-depth interviews and focus group discussions (FGDs) with girls and women, school counsellors/administrators, prison authorities, community health workers and physicians, as well as street vendors of medications.

The study shows that between February 2019 - January 2020, there were 185 cases of unsafe abortions recorded in health facilities within the 13 villages of Ngoketunjia Division. This number was recorded during hospital visits for management of post abortive complications and therefore might be much lower than the actual number of cases of abortions in these communities as home treatment/and death at home might not have been captured in hospital records where RuWCED provides financial support to access post abortion care for rural marginalised women/girls. The main drivers of these abortions were parental/societal pressure, pregnancy resulting from rape, lack of access to contraception by virtue of age limitation, family planning failure, not being ready for pregnancy as well as the restrictive and complex legal framework governing safe abortion. Common complications and consequences recorded in the communities were continuous bleeding, perforation, sepsis, recurrent abortions, infertility and dead. On the whole, where the reasons for abortion tied with what the law permits, the victims were either ignorant, not acquainted with the procedures prescribed, lack required means to successfully follow these procedures, or the providers were not fully aware of existing legal provisions allowing for an abortion or held deep value judgements that prevented them from providing the services.

Reducing the burden of unsafe abortion entails educating and sensitizing the communities especially young girls and women of reproductive ages on the importance of family planning and contraception as well as improving access to age appropriate SRH services especially among youths, to decrease the number of unwanted pregnancies. Also, it will be imperative to educate service providers on legal provisions and procedures surrounding abortion. The lack of knowledge and access to national guidelines on safe abortion leaves health personnel confused whether such guidelines exist and what is expected of them even within the restrictive boundaries of the existing laws. In this respect, it is pertinent to address the policy gaps (legal provisions of abortion services and violations of SRHR). These will contribute in the reduction of the prevalence and incidence of unsafe abortions in Cameroon.