CHAPTER ONE

INTRODUCTION

1.1 Background

Unintended pregnancy is a universal issue which affects women, their families and the society. These are pregnancies that are mistimed, unplanned or unwanted at the time of conception (Samuel, 2019). Unintended pregnancy is among the most troubling public health problems and a major reproductive health issue including accidental pregnancy and is defined as a pregnancy that was undesired for one or both of the partners (Mansureh, et al., 2015).

Unintended pregnancy is a global concern affecting both developed and developing countries. Over the past decade, unintended pregnancy prevalence rate ranged from 15 to 58% of pregnancies in the countries of North Africa and the Middle East (Sedgh, et al., 2014). Its prevalence rate was estimated as 58% in Yemen, 38% in Palestine, 32% in Morocco, and 31% in Syria and Algeria. In Egypt, it was estimated to be 23% (Eman, et al., 2019). The reported prevalence of unintended pregnancies in Pakistan is between 16-46% (Habib, et al., 2017). According to the Ethiopian Demographic and Health Survey report the prevalence of mistimed and unwanted pregnancies in Ethiopia was found to be 17.00% and 8.00% pregnancies were mistimed and unwanted, respectively (ECSA, 2017). In Cameroon, the phenomenon of unwanted pregnancies is acute, especially among adolescents. A study showed that the prevalence of these pregnancies is 24% among adolescent students in the city of Yaoundé (Ngomba, et al., 2017).

It is believed that poverty, stigmatisation of unmarried mothers, a cultural preference for sons, competing demands on women’s time, and the non-use and inconsistent or incorrect use of effective contraceptive methods among many others are the underlining causes of unintended pregnancy (Singh, et al., 2010; CDC, 2015). Previous studies done on unintended pregnancy revealed that different factors contributed for unintended pregnancy. For instance, a study indicated that not using contraceptive methods such as condoms, oral contraceptives, injections, implants and Intrauterine Devices (IUD) was associated with unintended pregnancy (Cherie, et al., 2018). Similarly, another study revealed that having multiple sexual partner, non-use of condom and non-consensual sex and sexual intercourse before high school were the potentiating factors of unintended pregnancy (Ma, et al., 2018).

Unintended pregnancy has a major impact on the lives of adolescents especially girls in terms of their health, social, economic and education outcomes (CDC, 2015). From 2010–2014, 59.00% of unintended pregnancies in developed regions, and 55.00% of unintended pregnancies in developing regions ended up with abortion (Dagnachew, et al., 2020). Unintended pregnancy has also been found to have severe implications for both the child and the mother. For instance, unintended pregnancy is found to have negative effects on prenatal visits and care, physical health status, labour experience, pain during labour, and psychological status in the early postpartum period (Karac¸am, et al., 2011). It is also found to have negative effects on various aspects of maternal and child health and behaviour (Gipson, et al., 2018), as well as increased risks of maternal depression and parenting stress. Unintended pregnancies are also known to impose astronomical direct and indirect financial costs on individuals and couples as well as governments (Yazdkhasti, et al., 2015). There are additional psychosocial harms as a girl may experience stress or depression if she is not psychologically prepared for marriage, sex or pregnancy – especially when sex is coerced or non-consensual – if she is shunned by family or the community or if she is unable to seek reproductive health services (UNFPA, 2013).

To fight against this scourge, Cameroon, with the assistance of its national and international partners has invested more to improving access to family planning services for women of childbearing age. This investment has been materialized by the integration of family planning services in the Minimum Package of Activities (PMA) at all levels of the health pyramid (Ngomba, et al., 2017). The most life-saving and cost-effective means to prevent unintended pregnancy is to encourage modern family planning use. This approach may be achieved by liberalizing the cadre of clinicians who can provide long-term contraceptive methods and ‘de-medicalizing’ (e.g. through community-based distribution) methods such as pills, injectable and implants so that they can be distributed to harder-to-reach women. In addition, contraceptive counselling, which significantly increases adherence and user satisfaction with various methods, is an underutilized pregnancy prevention strategy (Cherie, et al., 2018).

Tackling this problem will go a long way towards achieving one of the Millennium Developmental Goals, which aims to reduce overall maternal mortality by two thirds by the year 2035 (Ma, et al., 2018). This study therefore aimed at determining girl’s knowledge on the causes and challenges faced in the prevention of unintended pregnancy in the Ndongo community, Buea. The findings are hoped to provide evidences for policymakers regarding efforts to reduce risks associated with unintended pregnancy in women of child bearing age.

1.2 Problem Statement

Unintended pregnancy is a mistimed, unplanned or unwanted at the time of conception. It is an important public health issue in both developing and developed countries (Cherie, et al., 2018). Unwanted pregnancy remains a major contemporary problem, given the negative consequences they inflict on families in general, in women of childbearing age and children below five years in particular. It has a major impact on the lives of adolescents especially girls in terms of their health, social, economic and education outcomes (CDC, 2015). Unintended pregnancy has several adverse outcomes. From these adverse outcomes, unsafe abortion is a major and critical one which leads to infection, hemorrhage, reproductive organ perforation, infertility and even death (Sedgh, et al., 2014). These unintended pregnancies are among other things, the origin of poverty, family instability and child and maternal morbidity and mortality (Ngomba, et al., 2017). Reducing the number of unplanned pregnancies is a key objective in public health to reduce the maternal mortality ratio, prevent the mother to child transmission of HIV and to empower women. In response to this, this study sought to assess girl’s knowledge on the causes and challenges faced in the prevention of unintended pregnancy among girls age 15 to 25 years at the Ndongo community, Buea. The study findings might lead to knowledge on how to prevent the consequences of such pregnancies and at least manage a healthy pregnancy.

1.3 Research Questions

1. What knowledge do girls have on the causes of unintended pregnancy?
2. What knowledge do girls have on the prevention of unintended pregnancy?
3. What are the challenges faced by girls in the prevention of unintended pregnancy?

1.4 Objectives

1.4.1 General Objective

The main aim of this study was to assess knowledge on the causes of unintended pregnancy and the challenges faced in the prevention of unintended pregnancy among girls age 15 to 25 years in the Ndongo community, Buea.

1.4.2 Specific Objectives

1. To assess girls knowledge on the causes of unintended pregnancy in the Ndongo community
2. To assess girls knowledge on the prevention of unintended pregnancy in the Ndongo community
3. To identify the challenges faced by girls in the prevention of unintended pregnancy in the Ndongo community