TITLE:
Morbi-Mortality Linked to Unsafe Abortions—Difficulties in Accessing Safe Abortions in Cameroon: Meta-Analysis and Systematic Review
AUTHORS:
Florent Ymele Fouelifack, Mosman Anyimbi Ofeh, Jenny Ornella Manewoun, Nsen Abeng, Christophe Saha Lontsi, Mvong Vendeline Amaelle Goretti, Guy Sadeu Wafeu, Robinson Enow Mbu
KEYWORDS:
Morbi-Mortality, Unsafe, Difficulties, Access, Safe, Abortion, Cameroon
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.13 No.2,
February
28,
2023
ABSTRACT: Background: Unsafe abortions are one of
the leading causes of maternal mortality, especially in developing countries.
In Cameroon, the maternal mortality rate remains high, and the scarcity of data
on abortions leads to a lack of solid evidence to advocate on the extent of the
abortions related complications. Our objective was to evaluate the unsafe
abortions related complications, and to assess the difficulties of accessing
safe abortions in our setting. Methods: We carried out a meta-analytic
and systematic review in the biomedical databases MEDLINE (Pubmed), Google
Scholar and African Journal Online concerning unsafe abortions and/or
difficulties in accessing safe abortions in Cameroon. The keywords used for the
search are seen in table I. Selection of studies was simultaneously done by two
authors. Data were extracted through a form designed on Google Form. We used a
random-effect model for proportion estimation, and The I2 and Q
statistics to assess the extent of heterogeneity. Results: A total of
430 studies were identified, from which 28 were included and analysed. About 5%
(95% CI: 3 - 7) of unsafe abortions leads to death. The contribution of unsafe
abortions in maternal deaths was 23% (95% CI: 20 - 27). The rate of severe
bleeding and/or anemia were 40% (95% CI: 18 - 63) and the rate of infection was
17% (95% CI: 7 - 28), dominated by pelvic infections, pelviperitonitis, severe
sepsis, and septic shock. Case reports described uterine perforations, uterine
rupture during the following pregnancy. Abortion was performed in the
practitioner’s or patient’s home in 41.4% of cases, in a health center in 35.1%
of cases, in a private clinic in 21.2% of cases, drugs selling places and in
traditional healer clinics. The restriction of abortion laws, the stigma
surrounding abortion and its consequences at any level of the society, lead to
the underreporting of unsafe abortions and a deep reluctance to advocate for
safe abortion services. Conclusion: The strengthening of awareness
campaigns for provider behavior change communication, family planning, the
de-stigmatization of abortions, the training of health personnel in
post-abortion care, a multidisciplinary and multicentric action would
contribute to the reduction in morbidity and mortality due to abortions.