Eliminating the high abortion related complications and deaths in Cameroon: the restrictive legal atmosphere on abortions is no acceptable excuse

[Women's views on abortion legislation in Yaounde city]

Introduction

access to abortion is restrictive in Cameroon. The legislation authorizes the act in two cases: when the pregnancy results from a rape or when it puts the pregnant woman at serious risk for her health. Abortion outside this legal framework is considered illegal. This article identifies and analyses the opinions of women living in the capital Yaounde, on national legal provisions relating to abortion.

Methods

thirty-five (35) semi-structured interviews were conducted in Yaounde with women aged 19 to 40. Study participants recruited from consultations (family planning or maternal and child health service) contributed to the selection of other respondents using the snowball method. The data collected were the subject of a thematic analysis of content.

Results

more than half of those surveyed are against decriminalization. The transgressive dimension associated with abortion constitutes the main argument supporting the refusal of a possible relaxation of the legislation. The reason for health security is advanced in the opinions encouraging decriminalization. The difficulty of positioning oneself or the participants silence is an illustration of the sensitive nature of the subject of abortion.

Conclusion

abortion in its essence carries tensions emanating from interactions between institutional logics, social group norms and individual aspirations. The polarization of debates is a brake on the examination of the issue of decriminalization from a multidimensional perspective.

Unmet Need for Family Planning and Experience of Unintended Pregnancy Among Female Sex Workers in Urban Cameroon: Results From a National Cross-Sectional Study

Female sex workers (FSWs) in Cameroon have unmet need for effective contraception, and experience of unintended pregnancy and pregnancy termination is common. Reducing barriers to accessing high-quality, voluntary family planning services in FSW-focused community services is a key strategy to promote client-centered care, promote informed choice, reduce unintended pregnancies, and improve quality of life for FSWs.

Background:

Female sex workers (FSWs) in Cameroon commonly have unmet need for contraception posing a high risk of unintended pregnancy. Unintended pregnancy leads to a range of outcomes, and due to legal restrictions, FSWs often seek unsafe abortions. Aside from the high burden of HIV, little is known about the broader sexual and reproductive health of FSWs in Cameroon.

Methods:

From December 2015 to October 2016, we recruited FSWs aged ≥18 years through respondent-driven sampling across 5 Cameroonian cities. Cross-sectional data were collected through a behavioral questionnaire. Modified-robust Poisson regression was used to approximate adjusted prevalence ratios (aPR) for TOP and current use of effective nonbarrier contraception.

Results:

Among 2,255 FSWs (median age 28 years), 57.6% reported history of unintended pregnancy and 40.0% reported prior TOP. In multivariable analysis, TOP history was associated with current nonbarrier contraceptive use (aPR=1.23, 95% confidence interval [CI]=1.07, 1.42); ever using emergency contraception (aPR=1.34, 95% CI=1.17, 1.55); >60 clients in the past month (aPR=1.29, 95% CI= 1.07, 1.54) compared to ≤30; inconsistent condom use with clients (aPR=1.17, 95% CI=1.00, 1.37); ever experiencing physical violence (aPR=1.24, 95% CI=1.09, 1.42); and older age. Most (76.5%) women used male condoms for contraception, but only 33.2% reported consistent condom use with all partners. Overall, 26.4% of women reported currently using a nonbarrier contraceptive method, and 6.2% reported using a long-acting method. Previous TOP (aPR=1.41, 95%CI=1.16, 1.72) and ever using emergency contraception (aPR=2.70, 95% CI=2.23, 3.26) were associated with higher nonbarrier contraceptive use. Recent receipt of HIV information (aPR=0.72, 95% CI=0.59, 0.89) and membership in an FSW community-based organization (aPR=0.73, 95% CI=0.57, 0.92) were associated with lower use nonbarrier contraceptive use.

Conclusions:

Experience of unintended pregnancies and TOP is common among FSWs in Cameroon. Given the low use of nonbarrier contraceptive methods and inconsistent condom use, FSWs are at risk of repeat unintended pregnancies. Improved integration of client-centered, voluntary family planning within community-led HIV services may better support the sexual and reproductive health and human rights of FSWs consistent with the United Nations Declaration of Human Rights.

Availability, accessibility and utilization of post-abortion care in Sub-Saharan Africa: A systematic review

At the 1994 ICPD, sub-Saharan African (SSA) states pledged, inter alia, to guarantee quality post-abortion care (PAC) services. We synthesized existing research on PAC services provision, utilization and access in SSA since the 1994 ICPD. Generally, evidence on PAC is only available in a few countries in the sub-region. The available evidence however suggests that PAC constitutes a significant financial burden on public health systems in SSA; that accessibility, utilization and availability of PAC services have expanded during the period; and that worrying inequities characterize PAC services. Manual and electrical vacuum aspiration and medication abortion drugs are increasingly common PAC methods in SSA, but poor-quality treatment methods persist in many contexts. Complex socio-economic, infrastructural, cultural and political factors mediate the availability, accessibility and utilization of PAC services in SSA. Interventions that have been implemented to improve different aspects of PAC in the sub-region have had variable levels of success. Underexplored themes in the existing literature include the individual and household level costs of PAC; the quality of PAC services; the provision of non-abortion reproductive health services in the context of PAC; and health care provider-community partnerships.

Abortion practices among women in Buea: a socio-legal investigation

Introduction

there are controversies surrounding the practice of abortion especially in developing countries of Africa. Cameroon is not an exception to this and hence this study aims at assessing knowledge on the awareness of abortion laws, the factors that determine abortion and people's perceptions on the legality of abortion in Cameroon.

Methods

the study is cross-sectional in its design. A total of 224 women were randomly sampled. Data for the study were collected through the use of questionnaires from the sampled women of child bearing age. These were used to assess knowledge on the awareness of abortion laws and the determinants of abortion. The data were analysed using STATA 15.

Results

the prevalence of induced abortion was 21%. The major determinants of abortion among these women were; desire to stay in school (28%), fear of parents (24%) and shame of being pregnant out of wedlock (26%). Furthermore, many women are not aware of the situations where abortion is allowed and hence some still undertake illegal abortions even when they find themselves in situations deserving a legal abortion.

Conclusion

induced abortion is still common in Buea, Cameroon despite the fact that it is illegal. Cameroon's legal and health system needs to work in harmony in order to lessen the legal processes of having a legal abortion.

Safe abortion: The public health rationale

It is now more than 50 years since the World Health Assembly recognized abortion as a serious public health problem. The challenge still stands. Addressing the problem of unsafe abortion is a national and global public health imperative, dictated by the magnitude of the problem and its impact on individuals and society, inequity of the burden of disease, and an international consensus of the global health community. Almost every abortion death and disability could be prevented through cost-effective public health interventions including sexuality education, use of effective contraception, provision of safe, legal induced abortion, and quality humane postabortion care. Safe abortion continues to be a challenge to public health because of diverse national restrictive legal regulations, prevailing stigma, and lack of political commitment. Health professionals have a social responsibility to educate policymakers, legislators, and the public at large about adverse impacts of restrictive abortion regulations, laws, and policies on women's health.