CONTRACEPTIVE AND ABORTION PRACTICES AMONG UNDERGRADUATE FEMALE STUDENTS OF THE FACULTY OF HEALTH SCIENCES, UNIVERSITY OF BUEA

Abstract

The rate of premarital sexual activity, unwanted pregnancies, and illegal abortion remains higher among university students.

Unsafe abortion and its complications are a public health concern especially among female youths in Sub Saharan Africa since it is highly restricted but however done  clandestinely under unsaved medical conditions.

Thus associated with increased morbidity and mortality. Annually an estimated 24.4 million adolescents resort to abortion worldwide and  WHO estimate of unsafe abortion  revealed that in Africa youth between 15-24yrs account for more than 50% of all abortion related mortality. According to the Cameroon Society of Gynaecologists and Obtetricians, 30-40 % of maternal mortality in Cameroon can be attributed to unsafe abortions.

The aim of this study is to assess the knowledge and practice of contraception among the undergraduate female students in the Faculty of Health Sciences and to determine the utilisation rates of the contraceptive and    abortion methods practiced by the students.

The study was a descriptive cross-sectional survey of the female students in the Faculty of Health Sciences, University of Buea.

A pre-tested, self-administered semi-structured questionnaire was used to assess the different variables it seeks to study, using Campus B of the University of Buea as its location.

Female undergraduates of the Faculty of Health Sciences FHS constitute the study population. 250 questionnaires were administered and only 170 were returned in good order.  Data was analysed using SPSS.

Results showed that 74% of the female university students are young, sexually active adults or adolescents who are unmarried, but in relationships that predisposes them to unprotected sexual intercourse and other unsafe sexual practices.

94.1% of the female students were knowledgeable about contraceptives and abortion with the male condom and dilatation and curettage being the most widely used and practiced respectively.

The study, therefore, recommends that the university population should be educated on the dangers of unsafe abortion and its complications. This can be achieved through health campaigns, programs on television and radio, and by organizing seminars on contraception and abortion.

CHAPTER ONE

INTRODUCTION

1.1 Background

It is shown that out of 210 Million pregnancies occurring in the world annually, about 79million are estimated to be unintended of these 50 % end up in abortion [1]. It is also shown that 2 in every pregnancy worldwide are unplanned and reported that 10-14 % of young unmarried women around the world have unwanted pregnancy [2].

In Developing countries more than one–third of all pregnancies are considered unintended and about 19 % will end up in abortion, which is most often unsafe accounting for 13 % of maternal deaths globally[3].

It is also reported that between 20- 40% of all births occurring in developing countries are unwanted posing hardships for families and jeopardizing the health of millions of women and children [4]. In sub-Saharan Africa, it is estimated that 14million unintended pregnancies occur every year, with almost half occurring among women aged 15-24 years [5].

The same is reflected for Cameroon as a study done among youths showed that 27.1% of pregnancies were unplanned [6].

There must indeed be something about the sexuality of the people within this age bracket which motivates them to indulge in unprotected sex despite the fact that their environment is replete with different types of contraceptive devices such as Male condoms, Female condoms, Withdrawal Method, Pills, Injection, IUD, Foam/Jelly spermicide, Herbal Concoction and Gin [7]. Contraceptive methods can remarkably reduce the rate of unwanted pregnancies as it is shown that in countries where contraceptive use is very high, the rate of unwanted pregnancies as well as abortion has declined [1].

There is indeed a great cause for concern as regards understanding the sexual behaviors of these students, their knowledge of contraceptives, contraceptive use , the barriers to contraception among this high risk group if the incidence of unintended pregnancy, illegal abortions and high sexual behavior are to be minimised [7].

WHO estimates 2012 that out of 400,000 conceptions that occur per day, half are unplanned. One of the health targets of the millennium development goals is to reduce maternal mortality by about 75% by 2015 [8].

Emergency contraception has been shown to prevent about 85% of unintended pregnancies and is, therefore, one critical way of reducing our high maternal morbidity and mortality rates associated with abortion [5][9].

In Cameroon like in other Sub Saharan countries like Nigeria, induced abortion is illegal except in circumstances where the life of a woman is in jeopardy during the pregnancy [10].

However, it is worth noting that despite the restrictive abortion law, the incidence of induced abortion is widespread in Cameroon and its practice takes many forms among Cameroonian women of reproductive age [10]. It is for the reason of this restriction that most abortion procedures  in Cameroon are clandestine, and many are carried out in unsafe circumstances and are therefore classified as unsafe abortion.

Reports from the Cameroonian Society of Gynaecologists and Obstericians (SOGC) suggests that in Cameroon, abortion rate is estimated at 2.3% [11]. Moreover SOGC estimates 30-40% of maternal mortality in Cameroon can be attributed to unsafe abortions representing 2007-2676 maternal deaths due to abortion each year [11].

In 1995, the number of unsafe abortions performed in Cameroon as a whole was estimated at 25-2 per 1000 women which declined by 2000 to 20-25 per 1,000 women aged 15 to 49 years[15].In 2000 the estimated ratio of deaths due to unsafe abortion in Cameroon was still high at 0 t 1000,000 live births [12].

The reasons that are usually evoked by women to explain why they terminate a pregnancy are diversified. In a study conducted by Bazira in 1992 in Uganda the reasons for committing abortion included 50% wanted to continue their education,25.7% because of fear of their parents,8.3% could not afford to care for a child,3.0% had a spouse who did not want a child at that time and 5.3% had completed their families [13].

In view of the foregoing, this study will seek to determine the attitude of female university students towards the use of contraceptives and the pervasiveness of unprotected sexual intercourse among them.

It will also attempt to estimate the prevalence of induced abortion procured in unsafe form by female university students as well as evaluate the morbid consequences of post-abortion complications among female university students.

Therefore, it is hoped that this study will not only further strengthen the body of knowledge understanding of factors which predispose female university students to rampant sexual intercourse.

It is envisaged that its findings will be used by the appropriate bodies towards policy pronouncements capable of in the area of reproductive health, but also help in the in the better promoting the use of contraceptives among female adolescents, and that it will prompt more works in this area.

Suggested: The Effective Use Of Contraceptive Among Youths In Molyko Community

1.2 Problem Statement

In Cameroon, most of the unwanted pregnancies and induced abortions occur among the youths e.g. a study done in Cameroon among youths showed that 27.1% of pregnancies were unplanned [6] and another hospital based study done in Hôpital Generale Yaounde, in 2014 showed that 60% of patients admitted with an incomplete abortion stated that it had been induced and among these women 88% of them were less than 24 years, and 55% were less than 20 years [13].

In Cameroon, the contraceptive prevalence between females aged 15-49 years rate was at 23.4% in 2011 [14]. This low contraceptive prevalence gives us the reflection of the magnitude of unplanned /unwanted pregnancies, unsafe abortions and their complications, maternal and infant mortality.

This is much of a problem among the youths , because majority of them are facing various problems with regards to their reproductive health needs including contraceptive use i.e. services are not protecting the youths from infections as well as unplanned pregnancies, this is due to the fact that there is limited access to contraceptive to this vulnerable group, the barriers may include lack of information, misinformation, fear of side effects as well as social, cultural and economic barriers in accessing the family planning services (15).

Surveys have shown that, on average 43 percent of women in Sub-Saharan Africa has had premarital sex before age 20, for instance median age at first intercourse among young women in Ethiopia, Cameroon, Kenya and Niger is 16, 15.9, 16.8 and 15.3 respectively from Africa [15]. This increase in sexual activity puts young people at a great risk of unintended pregnancies as well as other STI’s including HIV/AIDS [16].

Adolescents have the highest risk of serious complications from the unsafe abortion, this is worse in countries like Cameroon, were abortion is restricted by law [11].

It is estimated that 46 million abortions are performed each year, 20 million of which occur in countries where abortion is prohibited by law [17].

1.3 Justification of the Study

An understanding of  the  magnitude  of unwanted  pregnancy , induced abortion and its complications  among  youths, as well as the factors that are associated with them  such as the low  use of contraceptives and the barriers to contraception use ( personal, cultural, or religious  objections, fear of side effects, health concerns, and lack of knowledge about contraception or where to purchase them)  at the university  level, is very crucial in designing and implementing interventions that could be tailored to youths needs, there by contributing in the attainment of the MDG 5 (Reduction in maternal mortality) [2].

Also, it is hoped that this study will not only further strengthen the body of knowledge about factors which predispose female university students to rampant sexual intercourse but it is envisaged that, its findings will be used by the appropriate bodies towards policy pronouncements capable of improving in the area of reproductive health, and also help in better promoting the use of contraceptives among female university students.

This is so because contraceptive methods have been proven to remarkably reduce the rate of unwanted pregnancies as it is shown that in countries were contraceptive use is very high, the rate of unwanted pregnancies, infant and maternal mortality as well as abortion has declined.

1.4 Research Goal

The goal of this research is to provide data on the common contraceptives practices by the students .This information obtained, will be of utmost importance not only in prevention of unwanted pregnancies and unsafe illegal abortions but also in the reduction of infant and maternal mortality and morbidity as well as in the prevention of Sexually Transmitted Infections (STI’s) and HIV/AIDS.

1.5 Research Objectives

1.5.1 General objectives

To determine the contraceptive and abortion practices among the undergraduate female students in the Faculty of Health Sciences.

1.5.2 Specific objectives

1. Analyse the methods of contraception and abortion practiced by the female students of the F.H.S University of Buea.
2. Describe the methods of abortion practiced by the female undergraduates.
3. Determine the utilisation rate of the different methods of contraception and abortion.