In Cameroon, where abortion may be performed legally only in cases of medical necessity or rape, a high proportion of young urban women have had at least one abortion.1 One in five 20-29-year-old women surveyed in Yaoundé in 1997 said that they had had an abortion. Four-fifths of the procedures they reported had been performed by a physician or nurse, but the methods used were not always the safest ones, and complications were common. Men in the sample also reported a substantial level of involvement in pregnancies ending in abortion; they were less likely than women to say that the procedure had been performed by a trained practitioner. The odds that a pregnancy would end in abortion were sharply elevated among women who were in school, were in consensual unions or had been involved with their partner for a year or less; the odds were reduced if a woman had no children.
The sample was drawn from among women and men in their 20s living in randomly selected households in Cameroon's capital. During in-person interviews, participants--180 women and 204 men--were asked about their background characteristics, sexual partners, reproductive history and experience with abortion. The questionnaire and the interview process were designed to encourage open discussion about abortion.
Twenty-one percent of women reported having had an abortion; among these, 40% had had two or more. Men's responses regarding their partners' experiences were fairly consistent with the women's reports: Twenty-nine percent said that they had ever been involved in a pregnancy that ended in abortion; 32% had had at least two such experiences. Overall, 35% of reported pregnancies had ended in abortion.
Women who had ever had an abortion were about the same age as those who had not (23-24 years), but they were more likely to be employed (37% vs. 17%), to be single (76% vs. 53%) and to have been pregnant more than twice (50% vs. 16%). On average, they had first had sex at a younger age than women who had never had an abortion (16 vs. 17 years) and had had more partners (seven vs. four).
Fewer differences distinguished men who had been involved in a pregnancy that ended in abortion from others: Both groups reported an average age of about 23 years and relatively high levels of education; the majority were either in school or working and were single. However, men with any abortion experience reported an earlier age at sexual initiation (15 vs. 16 years) and more partners (21 vs. 12); 73% of men with no abortion experience had never made a woman pregnant.
Overall, 67% of reported abortions (84% of procedures reported by women and 56% of those reported by men) had been performed by a physician or nurse. Larger proportions of men than of women said that the abortion had been performed by a traditional practitioner (14% vs. 8%) or by a friend, a relative or the woman herself (21% vs. 8%). Ten percent of men did not know who had provided the abortion.
Despite women's reliance on trained professionals, abortions in Yaoundé are not always performed by the safest methods. One in three abortions had been accomplished by means of dilation and curettage or aspiration, but one in five had involved riskier techniques using a catheter or an injection. Virtually all women knew what method had been used, and 44% reported safe methods. By contrast, nearly four in 10 men did not know how the abortion had been achieved, and only three in 10 reported the safest methods.
One in four respondents--21% of women and 28% of men--reported that an abortion had been followed by complications. Ten percent of men did not know if their partners had suffered any complications. Reported complications were less common after procedures performed by physicians (22%) or nurses (14%) than after those obtained from other sources (41-43%). The most frequently reported complications were abdominal pain (18%), abnormal bleeding (16%), fatigue (13%) and infection (10%).
According to the women, 19% of their abortions had been performed without their partner's knowledge, 31% had occurred with his knowledge but without his consent, and 50% had been obtained with his agreement. In 77% of cases, women reported that the decision to obtain an abortion had been theirs alone; they said that 19% had involved joint decision-making and 3% had been their partners' decision. Nevertheless, women said that their partners had paid for more than half of reported abortions (55%), while they had paid for 31% and their families or friends had paid for the rest.
Men's description of their partners' experiences give a somewhat different impression of their involvement in abortion decision-making. They reported not knowing about 13% of abortions at the time the procedures occurred, objecting to 23% and supporting 65%. Men said that more than half of abortion decisions (55%) had been made jointly and one-third (34%) by the woman alone; they reported that they had made the decision in 7% of cases and other people had done so in the remaining 5%. According to men's reports, they, their partners and a variety of other sources had been about equally likely to pay for the abortion.
For women, the main factors motivating the decision to terminate a pregnancy were the desire to complete their education (mentioned by 26% of respondents) and the sense that their relationship was unstable (23%). Substantial proportions considered themselves too young to have a child or feared their parents' reaction (19%), or cited a need to space their births (15%). Economic constraints and health concerns motivated the decision for 10% and 5%, respectively; 3% said the decision had been forced on them. By contrast, among men who had agreed with the abortion decision, the primary motivations were financial concerns (45%) and the feeling that they were too young (39%). Small proportions of men had been concerned about the woman's well-being (7%), the stability of the relationship (5%), the number of children they already had (2%) or other factors (2%).
The researcher conducted logistic regression analyses to determine which characteristics of the women, their partners and their sexual relationships were independently associated with the likelihood that a pregnancy would end in abortion. These analyses revealed that abortion was significantly more likely if a woman was in school than if she was out of school or unemployed (odds ratio, 7.5) and less likely if she had no children than if she had two or more (0.1). Partners' characteristics, which were significant at the univariate level, were not associated with the odds of abortion when all factors were considered simultaneously. Two relationship characteristics had significant effects: The odds of a pregnancy's ending in abortion were higher among women in consensual unions than among those who were legally married (5.3), and were elevated if the couple had been involved for one year or less (4.2).
Summing up her findings, the investigator notes that in Yaoundé, where modern contraceptive use is uncommon, "induced abortion seems...to play a major role in the postponement and regulation of childbearing among adolescents and young adults." She suggests that data from a more diverse sample would be useful for evaluating intergenerational and life-course variations and rural-urban differences among women with regard to abortion practices, decision-making processes, risk and motivations.--D. Hollander
REFERENCE
1. Calvès AE, Abortion risk and decisionmaking among young people in urban Cameroon, Studies in Family Planning, 2002, 33(3):249-260.