ABSTRACT

BACKGROUND Throughout centuries, women have been engaging in abortion. Some of these abortions done are safe because they are legal in some countries and also have good medical facilities and health personnel. However, in countries where abortion is illegal, people tend to talk less about it and the practice is done in hidden places whereby poor medical equipment are used and people who are not trained in the field perform these abortion procedures leading to unsafe abortion. This study stipulates that adolescents perform these abortions in unsafe places due to lack of knowledge on the effects of unsafe abortion. Therefore, this study was made to assess adolescent’s knowledge on unsafe abortion and its effects on reproductive health. METHOD This was a cross sectional study with a total sample size of 150 participants from the Molyko health area. The data collection tool was a questionnaire composed of closed ended questions to test the participant’s knowledge on abortion and the effects of abortion. RESULT A total of 150 participants were enrolled into the study of which 80 (53.3%) were single, a majority of 68 (45.3%) had a secondary education. Knowledge on abortion was significantly associated to Marital status (p=0.045) and Occupation (p=0.009).CONCLUSION Adolescents face a lack of information on abortion, without knowledge, many of them still resort to dangerous solutions when most of these services are accessible, another signal of both system and structural failures inherent in existing service systems.

CHAPTER ONE
INTRODUCTION

1.1 Background 

All over the world, women experience unwanted pregnancy and some of these women seek to terminate the pregnancy by safe medical means, if possible but often by whatever means available. The termination of pregnancies most generally known as “abortion” is a universal phenomenon occurring throughout all levels of societal organization and recorded history (Bolarinwa, et al., 2020).

Abortion is defined as the deliberate termination of pregnancy before the age of viability (28 weeks of gestation). Abortion may occur spontaneously or intentionally, the later also known as induced abortion, which may be either safe or unsafe (Yogi, et al., 2018).

Unsafe abortion is of public health concern because of its severe reproductive health effects and impact on maternal morbidity and mortality. The World Health Organization (WHO) defines unsafe abortion as a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both. Each year, an estimated 210 million women throughout the world become pregnant and about one in five of them resort to abortion. Out of 46 million abortions performed annually, 19 million are estimated to be unsafe (Espinoza, et al., 2020). The burden of unsafe abortion lies primarily in the developing world; the highest rates are in Africa and in Latin America and the Caribbean. In Africa, East Africa has the highest rate, at 38, followed by Middle Africa at 36, West Africa at 28 and North Africa at 18 (WHO, 2018). In Cameroon, the prevalence of unsafe abortion is about 25% and in 2017, the estimated maternal mortality ratio attributed to unsafe abortion in Cameroon was 90 to 100,000 live births (Mbuwir & Essimien, 2019).

In many countries, adolescents comprise a significant proportion of abortion seekers. For example, 59 % of all unsafe abortions in Africa are estimated to occur to women aged less than 25 years. Adolescents terminate unplanned pregnancies for various reasons, some of which include; fear of expulsion from school, social stigma surrounding unintended pregnancies, fear of not getting a husband in the future, fear of the parents to find out about the pregnancy and disapprove, unstable relationships, financial instability and lack of support from the partner amongst others (Cadmus & Owoaje, 2019).

Abortion can be legal or illegal, that is, generally acceptance by law, which is legal or unacceptable by law which is illegal, and regards it as an offence. Only few countries in Africa, allow abortion and problems relating to pregnancy are the leading causes of death for women of childbearing age(s), with complications from abortion consistently rendering at the top list (Kemfang, et al., 2015). In Cameroon, induced abortion is only permitted when a woman’s life is at risk, to preserve her physical and mental health, and on grounds of rape or incest (Mbuwir & Essimien, 2019). Where access to safe abortion is restricted, complications from unsafe abortion lead to morbidity and are a major cause of maternal deaths. Unsafe abortions can endanger women’s reproductive health and lead to serious, often life-threatening complications (Yogi, et al., 2018). Abortion during adolescence has led to deaths and health effects such as barrenness, sterility, infections of the womb, injury to the uterus, heavy bleeding, and chronic pains amongst others (Hord & Wolf, 2014). The detrimental effect is not only limited to the individual but also affects the entire healthcare system of a country, with the treatment of complications consuming a significant portion of resources (e.g., hospital beds, blood supply, drugs, etc.) (Johnson-Hanks, 2012).

Nevertheless, adolescents in Cameroon have continued to seek for abortion with unqualified physicians providing the services in private clinics and hospital where in most cases unsafe methods are used resulting to severe health effects or even death among the adolescents (Espinoza, et al., 2020). Ignorance/ lack of adolescents knowledge of sex, possible effects and dangers associated with abortion might be factors causing this problem. 

1.2 Problem Statement 

Adolescent pregnancy poses significant public health concerns worldwide. Nearly half of these pregnancies are unplanned, and half of those unplanned end in induced abortions (Darroch et al., 2016). The rising burden of unsafe abortion and the resultant magnitude of severe complications constitute a significant public health challenge. Nevertheless, adolescents in Cameroon have continued to seek for abortion with unqualified physicians providing the services in private clinics and hospital where in most cases unsafe methods are used resulting to severe health effects or even death among the adolescents (Espinoza, et al., 2020). Inspite of the existing knowledge on abortion, there exist little or no study assessing knowledge on unsafe abortion and its effects on reproductive health amongst adolescents in the Molyko health area. 

Therefore, understanding this field is essential to provide sufficient response to their sexual and reproductive health needs. We therefore sought to assess adolescent’s knowledge on abortion and its effects on the reproductive health in the Molyko health area, Buea.

1.3 Research Questions 

1. What knowledge do adolescents in the molyko heath area have on unsafe abortion?
2. What do adolescents in the molyko health area know about the effects of unsafe abortion on the reproductive health of women?
3. What are the determinants of knowledge on unsafe abortion and its effects on reproductive health amongst adolescent in the molyko health area?

1.4 Objectives 

1.4.1 General Objective

The main aim of this study was to assess knowledge on unsafe abortion and its effects on the reproductive health of women amongst adolescents in the Molyko Health Area, Buea.

1.4.2 Specific Objectives 

1. To assess adolescent’s knowledge on unsafe abortion
2. To assess adolescent’s knowledge on the effects of unsafe abortion on the reproductive health of women
3. To assess the determinants of knowledge on unsafe abortion and its effects on reproductive health amongst adolescents.