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(PAC) Services in Buea Journal of Complementary and Alternative Medical Research 15(4): 1-10, 2021; Article no.JOCAMR.72515 ISSN: 2456-6276 An Assessment of Women’s Experiences and Challenges Faced with Post Abortion Care (PAC) Services in Buea Teng Esther Mbong1,2,3*, Dickson S. Nsagha4, Niba Clinton Ambe3, Micheal Okunlola5 and A. Oladokun Sina5 1Department of Obstetrics and Gynecology, Pan African University of Life and Earth Sciences, University of Ibadan, Ibadan-Nigeria. 2Department of obstetrics and Gynecology, Buea Regional Hospital, Bokwaongo Buea, SWR, Cameroon. 3Department of Nursing, Faculty of Health Sciences, University of Buea, P.O. Box 63, Bomaka Buea, Cameroon. 4Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 12, Buea, Cameroon. 5Department of Gynecology and Obstetrics, College of Medicine University of Ibadan, Ibadan, Nigeria. Authors’ contributions This work was carried out in collaboration among all authors. Author TEM Conceived of the presented ideas, did key internet search and wrote down the manuscript, author NCA Supervised the methodology of the work. Author DSN Supported to develop ideas, encouraged and did key search for relevant data. Also contributed in the manuscript development. Authors MO and AOS Designated the analysis and supervised the finding of this work. All authors read and approved the final manuscript. Article Information DOI: 10.9734/JOCAMR/2021/v15i430271 Editor(s): (1) Prof. Arun Singh, Bareilly International University, India. Reviewers: (1) Marin Cuellar Torriente, University of Free State. South Africa. (2) Ivanova Liudmila, Kuban State Medical University, Russia. Complete Peer review History: https://www.sdiarticle4.com/review-history/72515 Received 20 June 2021 Accepted 24 August 2021 Original Research Article Published 26 August 2021 ABSTRACT Background: Unsafe abortion is one of the commonest causes of maternal mortality and post- abortion care services have been acclaimed as the best remedy for this situation. Yet, high maternal mortality still prevails pointing to issues with the quality of services. The paper was _____________________________________________________________________________________________________ *Corresponding author: E-mail: [email protected]; Mbong et al.; JOCAMR, 15(4): 1-10, 2021; Article no.JOCAMR.72515 designed to investigate women's motives for engaging in unsafe abortion; assess women's experiences on the quality of PAC services and identify the challenges women faced in accessing PAC services in Buea. Methods: This study recruited 10 participants in Buea. Using a structured interview, data was collected on women's motives for engaging in unsafe abortion; assess women's experiences on the quality of PAC services, and identify the challenges women faced in accessing PAC services in Buea. Thematic and grounded theory analytical techniques were used to organize and interpret the data. Results: Majority of women in Buea did not use contraceptives for different reasons ranging from personal, spousal consent, ignorance, and the fear of side effects of contraceptive use. The low contraceptive use accounts highly for unwanted pregnancy cases which results in the decisions to induce. Most of these women involuntarily engage in induced abortion, highly driven by second party influence like the request from spouse/partner, disappointment from the spouse, and fear of parents’ reactions; while some occur as a result of missed abortion. The quality of PAC services received by most of these women were merely emergency treatments without proper PAC activities like family planning counseling, provision of modern contraceptive methods, linkages to other reproductive health care services. Women in Buea encounter some challenges in the use of PAC services, pains associated with the procedure, the cost, the absence of some family planning methods, the absence of counselling before PAC and above all, non constant availability of blood in the bood bank for transfusion. Conclusion: This study concluded that most women in Buea engage in induced abortion on account of the pressure to terminate an unwanted pregnancy; resulting from low contraceptives use; desire to avoid problems from their spouses/partners as well as to pursue career ambition. Moreover, the quality of PAC services offered to women in Buea was emergency treatment; void of important aspects like family planning services, linkage to other reproductive health care services, and facilitating their social reinsertion and preventing future induce abortion. Keywords: Abortion; post-abortion care (PAC) services; women; contraceptives; Buea. 1. INTRODUCTION or allow it only to save the life of the woman [4] or protect her physical health, three-quarters of According to the World Health Organization the procedures are unsafe. It stresses the need (WHO), unsafe abortion is a procedure for for good quality post-abortion care to save lives terminating an unwanted pregnancy either by and to minimize the long-term consequences of persons deficienting the requisite skills or in an unsafe abortions. Therefore, abortion environment lacking minimal medical standards complexities are among the major arguments or both [1]. On the other hand, Post-abortion care women seek emergency obstetric care [4] and [5] (PAC) is a package of services offered to women noted that determinants of induced abortion may after an incomplete abortion due to spontaneous be very similar across all African countries. or an induced abortion [2]. PAC also includes services such as evaluation for sexually With growing arguments surrounding the practice transmitted infections, including HIV/AIDS. of abortion especially in developing countries of Africa [1], effective and efficient PAC services is Worldwide, access to quality abortion and post- a terrible need in these settings. Deaths from abortion care is a vital causal factor for women’s unsafe abortions in countries like Kenya is survival after an abortion- planned or unplanned approximately 35% [3], and Cameroon recorded [3]. It is approximated that of the 210 million a 13% rate from unsafe abortion and has been pregnancies that take place each year, about 80 associated with poor abortions, poor PAC million are unintentional and in 2008, 21.6 million practices, restrictive abortion laws (2), low unsafe abortions were estimated to have contraceptive uptake, gender-based violence, occurred, causing the deaths of 47 000 women economic hardships, religion, and cultural beliefs [3]. among others. Studies done in Cameroon have shown that In Africa, more than 8 million abortions occur abortion is a major public health problem, being each year, and three-fourths of them are unsafe. responsible for 30% of maternal mortality and In countries like Cameroon that prohibit abortion morbidity [6], with the prevalence of induced 2 Mbong et al.; JOCAMR, 15(4): 1-10, 2021; Article no.JOCAMR.72515 abortion of 26.3% [4]. The year 2000 and 2003 issues on women’s health including PAC, sex registered an estimated 20-29 unsafe abortions education, and family planning through the per 1000 women aged 15-49 [7]. More so, a effectiveness of public healthcare policies. To university teaching hospital report on Maternal buttress this, WHO estimates that 10-50% of mortality in Cameroon by [8] revealed that 25% women who undergo unsafe abortions require of deaths were attributed to unsafe abortion. medical care [14]. Besides, the 1994 International Conference on Population and Although developing and developed countries Development (ICPD) in Cairo, called for all have similar rates of induced abortion amongst women to have access to PAC services, women; such pregnancies and unsafe abortions regardless of the legal status of abortion [9]. The are most often concentrated in the developing Millennium Development Goal 5 too, aims at countries [9]. In countries where abortion is improving maternal health by reducing maternal legally restricted, safe abortion services are out- mortality by 75% from 1990 to 2015 and of-reach for many facing unwanted pregnancies providing universal access to reproductive health except to save a woman’s life [10]. [14]. The target of this former fifth MDG which was not attained by many African countries, has As the challenges of PAC services, a study been revised to be the current Sustainable revealed that about 4% of U.S. abortion patients Development Goal (SDG) 3, with the target to believe abortion should be illegal in all or most reduce maternal mortality ratio to less than 70 cases. There is some indication that women’s per 100,000 live births by 2030 (UN, 2015). views about abortion and abortion restrictions are different when examining their own experiences It is obvious that, with the growing population, with abortion than when reflecting on other inadequately resourced public health systems, women’s experiences. One study [11] found that and persistent shortages of skilled workforces, all abortion patients supported policies that they felt contribute to deficits in health worker’s practices could ensure informed decisions for “other [4]. women,” while they considered their decision- making to be well-informed and responsible. At Until recently, little studies have revealed the same time, many did not support waiting women's views, experiences, and challenges periods or financial restrictions and suggested toward PAC services in Cameroon, and as such, that the government does not show sufficient the reasons why this paper was designed. empathy for women who seek
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