FIGO WORKING GROUP ON UNSAFE ABORTION
SITUATIONAL ANALYSIS OF ABORTIONS IN CAMEROON
Florence Tumasang, Mbu Robinson, Nana Phiip, Robert Leke, Ngape,
Emmanuel
Introduction
Unsafe abortion is a common problem in Cameroon where it is responsible for
30% of emergency admissions and about 32% of maternal deaths. According to
Leke (1998), 41% of adolescents in school are sexually active.
Among
Cameroonian women aged 15-49 years, 25 % had sexual intercourse before
their 15th birthday (DHS, 2004). In the same DHS it was found that the age at
which women get into unions (traditional and or legal marriages, co-habitation) is
at least 1.3 years later than their first sexual intercourse. This means therefore
that any pregnancy occurring during this adventurous sexual intercourse may be
the reason to seek an abortion.
UNWANTED PREGNANCIES

The incidence of unwanted pregnancies is 38.6% in Cameroon.
Incidence of unwanted pregnancies
Incidence of unwanted pregnancies
% of births that are unplanned (mistimed and unwanted) (2004).1
% unwanted
% mistimed
% of births that are unplanned among adolescents (mistimed and
unwanted) (2004).1
% unwanted
% mistimed
22,1*
4,7
17,4
27,7**
1,9
25,8
* Percent of live births to women age 15-49 that were unplanned
(unwanted and mistimed=wanted later) in the 5 years preceding the
survey
** Percent of live births to women age 15-19 that were unplanned
(unwanted and, mistimed=wanted later) in the 5 years preceding the
survey
Page 1 of 18
(no information is available by age group for percent of live births to women in
the past 5 years as requested by the study).
Vulnerable groups include mostly internally displaced populations, unmarried
women HIV Positive Women, rural population,
and youth. Displacement of
population resulting from political instability is a regular phenomenon in our
region (refugees from Congo, Central African Republic and Chad). Young
women who are either displaced or voluntarily migrate to bigger cities find it
difficult to cope with the standards of living in such cities. They resort to
prostitution as means of living. Unwanted pregnancies and unsafe abortions are
a consequence.
Determinants of unwanted pregnancies include access to contraceptive,
violence against women, and lack of social support for pregnant women. In
youths some of the determinants include the fear of parents, the desire to pursue
their education and the fact that they are unmarried. Other determinants include
early and forced marriages and lack of adequate information on family planning
which could cause the dropping out of school and poverty. Sexual assault could
also be a determinant of unwanted pregnancies.
Characteristics of women with unwanted pregnancies include, those involved in
adolescent sexuality, early marriages, poverty, school drop outs and those with
low levels of education, women with low socio-economic status, area of
residence (poor neighborhoods, rural, urban, etc) EDS III.
The most common end results of unwanted pregnancies are unsafe abortions
which may result to short or long term complications such as infections, death or
infertility. These are consequences to the individual but the health services that
are already overburdened will have to deal with these complications and the
health needs of these women who get unwanted pregnancies.
Page 2 of 18
Only 13 % of Cameroon women use one of the modern methods of contraception
(DHS, 2004).
Barriers to the use of modern contraception include myths
surrounding their use, availability, taboos, Religion, opposition from husbands,
health reasons, and fear of secondary effects, culture and ignorance. 90% of the
women interviewed in the DHS of 2004 knew at least one modern method of
contraception. There is very high level of knowledge but equally very low use of
contraception especially modern contraception. Use of modern contraceptive
methods is very low among adolescents, one of the most vulnerable groups in
Cameroon, both in and out of school. When interviewed, most adolescents would
not seek for modern methods of contraception for fear of meeting their parents or
other adult family members in the services that offer family planning.
Unfortunately for Cameroon, family planning services are mopped up with other
reproductive health services. Adolescents and young adults would prefer a
reproductive health service streamlined to suit them.
A service where the health care providers are as young as they themselves, a
unit where other activities like games, reading, etc. are incorporated in order to
dilute attention towards any youth who may be interested in contraception. This
may explain why the relationship between contraceptive use and unwanted
pregnancies is inversely proportional.
INTERVENTIONS TO PREVENT UNWANTED PREGNANCIES AND INDUCED
ABORTIONS

Contraceptive information and services including EC
Overall and method specific prevalence rate
Overall contraceptive prevalence rate (2004)1
Any modern method
Any traditional method
Any method (Total modern and traditional)
12,5
13,5
26,0
Page 3 of 18
Specific methods-(2004)1
Pill
IUD
Injectables
Male condom
Female sterilization
Implants
LAM
Periodic abstinence
Withdrawal
Other
1,6
0,3
1,4
7,6
1,2
0,3
0,6
10,2
2,1
0,6
Overall 26% of Cameroonian women use contraception but only 13% use one or
other of modern contraceptive methods.
The methods approved and available in the country include the pill, , condoms,
emergency contraceptives, intrauterine device, the injectables, the Norplant and
bilateral tubal ligation (BTL) , spermicides, Bilings and other natural
methods(billings, LAM, periodic abstinence, ogino method, etc).
All modern methods are sold at subsidized rates but none are distributed free
today. This applies to public as well as private health structures.
According to the DHS 2004, only 6% of rural women use a modern method of
contraception. In all public health services in the rural areas, there is at least one
modern method available in urban as well as rural areas..
The data available on access of methods to young people is found in some
publications mostly from thesis done in the faculty of medicine of the University of
Yaoundé. . Data on use of traditional and Modern Contraceptive Methods by age
groups, women in genera, couples, unmarried and sexually active women. No
data is available for marginalized groups (rural people, indigenous groups,
refugees, IDPs) DHS 2004.
Contraceptive information among adolescents and young adults in colleges and
universities and also among the general population will unquestionably increase
contraceptive awareness.
Page 4 of 18
COMPREHENSIVE SEXUALITY EDUCATION
No information is available on the current situation of knowledge among women
and men on sexuality education.
There are governmental programs for comprehensive sex education in
secondary schools, beginning from the third year. Enormous efforts are being
made by Non Governmental Organizations (Camnafaw, FESADE, ACAFEM,
CESRAF/ALVF) and Religious bodies in out of school settings. Integration of
programs on sexuality education in school curricular is in process by the
Government
The Cameroon medical women’s Association has only recently initiated a youth
friendly health centre where out of school youth have been particularly involved.
A needs assessment study was carried out using focus group discussions to
determine what will be offered at this pilot youth friendly health centre.
Teachers do not receive any particular training to provide sexuality education.
See FESADE, UNESCO for technical orientation i.e. scope and content.
Social protection of pregnant women and mothers of small children
All employed pregnant women have three months paid leave made up of 8
weeks before delivery and 6 weeks after delivery. In addition all women who
have had babies have an hour and a half a day for breast feeding until their
babies are 18 months old according to our labour code.
The law making provision for parental leave and maternal breast feeding is
applied to the letter and varies between Government structures and private
outfits.
There are some whole day nurseries and both baby nurses and baby sitters are
easily available at low cost.
Adoption
Page 5 of 18

There is very little support for women who wish to give up babies for
adoption because of the traditional family structure.
There is almost
always a family member who is ready to take care of the baby.

Yes there is an effective legal procedure for adoption in Cameroon.
ABORTION

Incidence
Number of induced abortions
No national data is available. The only available information comes from
women admitted in some few health facilities, or from a plantation hospital
or workers from a palm oil company at Kienke or from the Principal
Maternity in the capital city (Yaoundé).

Reliability of data - Hospital based data, publications, students theses

Sources of data - Publications, theses, surveys, DHS 3.
UNSAFE ABORTION
Incidence - Difficulty to obtain exactly since not readily declared. Hospital
data suggests 34.5% of abortions are induced in Cameroon.
Number of hospital admissions for treatment of induced and
spontaneous abortions in 4 District hospitals* (June/94-May/95).2
324
Number of hospital admissions for treatment of induced abortion
in 4 District hospitals** (June/94-May/95).2
122
Number of hospital admissions for the treatment of induced and
spontaneous abortions at the Maternity Principale of Yaoundé***
(1997).3
2.324
* Based on women admitted to hospitals for first complication of the first
trimester of pregnancy during a 1 year study period
** 38% had an induced and 62% had a miscarriage (122 and 202,
respectively, out of 324 women). Induced likely underreported, since
information was dependent on women's statements.
Page 6 of 18
*** Data refers to 3 months study period in one health facility in the capital
city

What data are available on the magnitude and severity of the
problem of unsafe abortion? . A national study has just been conducted
on the magnitude of abortion in Cameroon (2007).


Source of data . Report of national study on magnitude of abortion.
Hospital admissions -prospective studies (1 year period and 3 months
duration). Data for the 4 District hospitals were collected by interviewing
women and from medical files, using a structured WHO questionnaire. Full
report for the sutdy carried out at the Maternity of Yaoundé was not
possible to obtain: Doc available at WHO data bank Refs 16465 (see
reference 3 below) Surveillance System.
Data are not current; they are for 1994-95 & 1997, about 10-13 years ago
and things may have changed somewhat. In addition, data is restrictive to
one or few health facilities.
All categories of women seek abortions but more frequently it the
adolescents (> 49% of abortions) and especially of the lower socioeconomic class. Both married and unmarried women as well as rural and
urban women seek abortion services.

Providers of unsafe abortions in Cameroon include, the pregnant women
themselves, traditional practitioners, paramedical personnel, medical
doctors, medical students and quacks.

Misopostol is available, registered and used for induction of labour.

It is available in both public and private pharmacies in Cameroon.
QUALITY OF THE CARE OF WOMEN CONSULTING FOR COMPLICATIONS
OF ABORTION
The methods used for care of women with incomplete abortions include dilatation
and curettage (D&C), uterine evacuation, digital exploration and to a lesser
extent manual vacuum aspiration.
D&C is available in most of the district
hospitals and health centers but manual vacuum aspiration is only available in
some city and town hospitals (public and private) as well as in university teaching
hospitals.
Page 7 of 18

The prices vary with the level of the hospital from as low as 700 francs in
some health centers to as high as 476,000 CFA francs in some private
institutions.

Access to post abortal care is mostly limited by financial means. There is
also stigmatization when young women or girls come for post abortal care.

Physicians and other health personnel are trained according to the
different curricular of their medical schools in relation to National norms
and not the WHO recommended methods. There has been limited training
in MVA technique.

We do not think we are implementing the WHO guidelines but the
implementation is tailored to fit the guidelines of the department of
reproductive health. (Ministry of Health)
CONSEQUENCES OF UNSAFE ABORTION
There are no official statistics on the magnitude of unsafe abortion and its
contribution to maternal morbidity and mortality at the national level,
however, complications of unsafe abortions are seen in health facilities
where studies have been carried out. For example, in Goyaux et al study
(Ref. 2 below) there were 5 fatality cases (4.1%) as a result of
complications of induced abortion and 2 fatality cases (1.0%) as a result of
complications of miscarriages.
Estimated number of maternal deaths (2005).4
Proportion of maternal deaths of female 15-49 years old (19982004).1
Proportion of maternal deaths among all deaths of female of
reproductive age (2005).4
Percent of maternal deaths that are due to unsafe abortion in the
subregion in which Cameroon falls (WHO estimate for 2003).5
Maternal Mortality Ratio reported, (deaths per 100,000 livebirths,
1998-2004).1
Maternal Mortality Ratio, adjusted 2005 (deaths per 100,000
livebirths).4
5.700*
19%**
37%#
17%
669&
1.000@
*Since there are no available data, we would like to recommend this
estimate. Data adjusted based on reviews by UNICEF, WHO, UNFPA and
Page 8 of 18
World Bank to account for well-documented problems of under reporting
and missclassification; data refer to most recent year available during
period specified.
** Based on direct counts, DHS data
We would like to recommend this estimate. Data adjusted based on
reviews by UNICEF, WHO, UNFPA and World Bank to account for welldocumented problems of under reporting and missclassification; data refer
to most recent year available during period specified.
Based on direct counts, sisterhood method, DHS data. Likely
underreported
We would like to recommend this estimate. See observations in row 105
above. Range of uncertainty of the MMR ranges between 670 and 1,400

Magnitude and severity of complications of unsafe abortion
Maternal mortality related to abortions is 993/100,000 live births, this is a lot
higher than even the very high rates of maternal mortality.
Unsafe abortions are responsible for 30-40 % of cases of maternal mortality
in Maternité Principale of the central hospital in Yaoundé. Increase in the rate
of secondary infertility as a long term consequence
Haemorrhage sometimes leading to shock and death of the mother.
Intestinal perforations as a consequence of unskilled practice.
Perforation of the uterus and bladder as results of unskilled aborters.

Is there an established national level mechanism for monitoring and
evaluation of maternal mortality and morbidity resulting from unsafe
abortion?
There is no National level mechanism for monitoring and evaluation of
maternal mortality and morbidity resulting from unsafe abortions

Cost of unsafe abortion to the health system, women and families
Unsafe abortions are very expensive to the health system, women and families. It
costs about 31,000 CFA francs and 70,000 CFA francs.
Page 9 of 18
High cost for individual and family health budget.
.National cost in management of post abortal care clinics.
LEGAL SITUATION OF ABORTION AND REGULATORY FRAMEWORK
National Laws:
Grounds on which abortion is permitted in Cameroon.6
To save the women’s life
To preserve women’s physical health
To preserve women’s mental health
Pregnancy resulting from rape or incest
Severe fetal malformation
Socioeconomic reasons
Women’s choice
Yes
No
No
Yes
Yes
No
No
* The law does not specify whether health includes physical and mental
health.
Additional requirements: An abortion must be performed by a qualified
person. In the case of rape, the prosecution or the public prosecutor’s office
must certify a “good case” or the materiality of the facts before the abortion
can lawfully be performed.

Therapeutic abortions are allowed in Cameroon legally to save the
woman’s life.

There is no provision for legal abortions to preserve a woman’s physical
health.

Abortions are not allowed by law to preserve women’s mental health.

The law allows for abortion of pregnancies resulting from rape, incest and
severe malformations that are not compatible with life.

Abortions are not legal for socioeconomic reasons or women’s choice.
It is important to note here that in each case where abortions can be carried
out legally, three medical doctors must sign to confirm the diagnosis.
Page 10 of 18
Regulatory framework-key elements
Abortion is illegal except in cases where the life of the woman is in danger.
Other exceptions include severe fetal malformations, rape and incest.
PROVISION OF LEGAL ABORTION SERVICES

For each indication, the law is being complied with.

The methods use for legal abortion, are dilation and curettage, Vacuum
aspiration and the use of misprostol, depending on the age of the
pregnancy. Injection of hypertonic saline was also used but is no longer
recommended.

These methods are available in secondary and tertiary hospitals and cost
between 50,000 CFA francs and 100,000 CFA francs.

Access to availability of legal abortion services is not known because most
people are ignorant about the indications for legal abortions in the country.

The WHO recommended methods for legal abortion are not taught to
physician and mid level providers. The methods used are the ones used in
our services as indicated above.

Yes, the country is implementing the WHO recommended list of essential
medicines that includes mife/miso and essential commodities list of WHO
and UNFPA that includes MVA. Manual vacuum aspirators are used in
teaching hospitals mostly, and in some private hospitals in tertiary areas.

FIGO ethics committee recommendations are only known to some
members who have had the opportunity to have them during training.
IN SITUATIONS OF RESTRICTIVE LAWS:

Women are rarely prosecuted or imprisoned because of induced
abortions. Heath personnel are not required to report the cases.

Health personnel generally follow the ethical principle of confidentiality of
health records in the care of women with induced abortions.

Physicians and other health professionals are rarely prosecuted but some
have gone to prison in cases that ended up in maternal mortality.
Page 11 of 18
Sources:
1
Institute National de la Statistique (INS) et ORC Macro, 2004, Enquête
Démographic et de Santé du Cameroon 2004, Calverton, Maryland, USA: INS et
ORC Macro.
2 Goyaux
N, Alihonou E, Diadhiou F, Leke R and Fernand Thonneau P,
Complications of induced abortion and miscarriage in three African countries: a
hospital-based study among WHO collaborating centers. Acta Obstetricia et
Gynecologica Scandinavica, 2001, 80(6):568-573.
3 Doc
available at WHO data bank reference #: RMN16465 Ngwe E, Kandem
Kamgno H. Connaissances, attitudes et pratiques face à l'avortement dans les
grandes villes camerounaises: evaluation à partir des données d'enquête.
UNPUBLISHED. UNPUBLISHED paper submitted to Abortion, Sessions for the
2005 IUSSP Conference, 2005. RefCat: ABO Subject: KAP Country: CAE UN
Region: 1 UN SubRegion:
4 Maternal
Mortality in 2005, estimates developed by WHO, UNICEF, UNFPA
and the World Bank, www.who.int/reproductivehealth/publications/maternal_mortality_2005/mme_2005.pdf, accessed January
28, 2008
5 WHO.
Unsafe Abortion: Global and regional estimates of the incidence of
unsafe abortion and associated mortality in 2003. Fifth Edition, Geneva 2007.
6 Population
Policy Data Bank maintained by the Population Division of the
Department of Economic and Social Affairs of the United Nations Secretariat.
Cameroon, Abortion Policy,
http://www.un.org/esa/population/publications/abortion/doc, accessed February
18, 2008.
Age
group
ASFR
(DHS
2004)*
15-19
20-24
25-29
30-34
35-39
40-44
45-49
0,138
0,236
0,231
0,194
0,126
0,053
0,016
2005
Estimates
of
national #
women*
(000)
996
868
698
551
445
368
304
Estimated
Live births,
2004
Estimated # of
maternal deaths
(subject to the MMR
used). In this case
the reported MMR
was 669***
137.448
204.848
161.238
106.894
56.070
19.504
4.864
Page 12 of 18
4,97
4.230
690.866
4.622
This # is lower than the estimated by WHO/UNICEF/UNFPA/WB
* Institute National de la Statistique (INS) et ORC Macro, 2004, Enquête
Démographic et de Santé du Cameroon 2004, Calverton, Maryland, USA: INS et
ORC Macro.
** Source: Population Division of the Department of Economic and Social Affairs
of the United Nations Secretariat, World Population Prospects: The 2006
Revision and World Urbanization Prospects: The 2005 Revision,
http://esa.un.org/unpp, Thursday, February 14, 2008; 11:31:33 AM.
*** Number of maternal deaths= (MMR *(annual number of live births/100000).
The annual number of live births is calculated using the age specific fertility rates
(DHS-2004) multiplied by the number of women in each age
Page 13 of 18
The Summary of the study on Magnitude of abortion in Cameroon
This first nationwide study on abortions was carried out between 2006 and 2007
Despite a significant increase in the use of contraception over the past decades
an estimated 40-50 millions abortions occur annually in the world and nearly half
of them 20 millions occur in unsafe conditions. Though it is estimated that 13 %
of all maternal deaths are due to complications of abortions, studies in the
Central Maternity of Cameroon reveal that 30-40% of all maternal deaths can be
attributed to complications of abortions. The true incidence of induced abortions
in Africa is difficult to determine because of the difficulty of getting patients admit
to have induced the abortion and because of socio-cultural determinants that do
not permit easy discussion on sex matters. In Yaoundé, Cameroon, studies have
shown that induced abortion is 50% more likely to cause maternal death than
normal delivery. True rate of induced abortion is difficult to estimate for the
following reasons: fear of stigmatisation, socio-cultural norms, financial
constraints and the tendency to protect the provider. The cost of induced abortion
is difficult to quantify and this cost is a burden to the individual, the family, the
community and the government. The present research on the magnitude of
abortions was conducted with the following objectives; determine the sociodemographic and reproductive profile of women having incomplete abortions in
public, private and faith based hospitals, the types and proportions of abortionrelated complications; evaluate the clinical management of incomplete abortion in
different hospital settings and estimate the national cost of treating abortion
complications in public hospitals.
Methodology: This was a multi-centre cross-sectional quantitative study with
stratified sampling design employed for data collection. The study population
consisted of all women presenting at the participating hospitals during the period
of data collection with the diagnosis of incomplete abortion or other abortionrelated complications from a pregnancy terminated up to 28 weeks gestation.
The data collection period was staggered over five weeks across the sites for
easy monitoring and supervision by the coordinator.
Page 14 of 18
Results: Patient distribution in the referral, provincial and district hospitals were
similar, 33.7%, 25.1%, 31% respectively. However, public institutions received
more patients (89.8%) than the private or faith-based institutions. Adolescent or
the less than 20 years represented a quarter of the patients (25%).
Three
quarters (75.7%) of the patients were managed within their town of residence. A
previous use of contraception or its current use before the actual pregnancy was
low 27.5% and 20:3% respectively. 38.5% of the pregnancies were not desired.
56.8% of the pregnancies were in the first trimester. The abortion was
associated with overt fever in 19.4% of cases, normal to low grade fever in
19.6% of cases.
abortion.
39% of the abortion could therefore be probable induced
6% of the patients had pulse rate above or equal 120/minute,
constituting the at risk group for probable induced abortion. 24.3% of the patients
showed pallor on clinical examination, which may be a consequence heavy
bleeding. Foreign body was seen in the genital tract in only 8.9% of the patients,
evidence of an induced abortion and correlated with the 8.4% signs of injury to
the genital tract. However, the products were offensive in 16.9%. Only 10.2% of
the patients concerted to haven induced the abortion, 18.4% denied any
manipulation while 71.5% gave no opinion. Haemoglobin analysis was carried
out in 25 % of the patients. The use of antibiotics was routine in all the patients
(95.3%), while IV fluids was used in half the patients (52.9%). Uterine evacuation
was done in 75.4% of the patients and the sharp curettage technique was most
utilised method (35.7%). All grades of the medical profession carried out uterine
evacuation, with the nurse/midwife dominating (27.3%). Four maternal deaths
were seen in the series giving a maternal mortality ratio of 997/100.000. The
national proportion of all abortions and that of incomplete abortion calculated
from this study are estimated to vary between 54.1-58.9% and 52.8-62.4%
respectively. The mean cost of abortion was estimated at 50670 FRS. With a
confidence interval of 95%, the mean cost of abortion in the Public hospitals of
Cameroon was estimated to range from 31055-70290 FRS.
Conclusion: Abortion in general and induced abortion more specifically is
associated with serious consequences to the patient and indirectly to the family,
Page 15 of 18
community and government. Prompt diagnosis and management is therefore
paramount. Training of service providers, the availability of the manual vacuum
aspirator in all health facilities, creation of abortion care units in most of our
hospitals will improve abortion care and consequently reduce maternal morbidity
and mortality.
Keywords: Induced abortion, incomplete abortion, maternal morbidity and
mortality, uterine evacuation.
Page 16 of 18
IN CONCLUSION
Unsafe abortions are a major problem in Cameroon taking up quite an important
part of the health budget and family finances. It also takes up a lot of time of
medical personnel who are already overwhelmed with work.
Abortion is still illegal in Cameroon and the rate of use of modern methods of
contraception is still very low, and adolescent sexual activity is precocious
resulting in unwanted pregnancies, which in turn result in the need for abortions
often turning out to be unsafe abortions.
Sexuality education needs to be intensified for all including parents, teachers and
both in and out of school youth.
Youth friendly health services have to be
created in all settings rural and urban to give the youth access to contraceptive
methods and sexuality education.
All health personnel should receive adequate training in the care of abortion
complications in all settings.
Those who take care of abortion complications could join other civil society
groups to advocate for better conditions in the hospitals and health centers with
equipment and medications for the management of abortion complications.
Page 17 of 18
REFERENCES
1. Demographic and Health Survey(DHS), of Cameroon .2004
2. Leke R. J .I. Awah P., Amin M. Trends and characteristics of abortion in
semi-rural and rural Cameroon. Unpublished report, 1997.
3. Leke R, J. I. Commentary on unwanted pregnancy and abortion
complications in Cameroon. Int. J. Gyneol. Obstet.,1989, Suppl. 3: 33-35
4. Goyaux N., Alihonou E., Diadhiou F., Leke R. Thonneaux P. F.
Complications of induced abortions and miscarriage in three African
countries: a hospital-based study among WHO collaborating centers.
Acta Obstet Gynecol scand 2001: 80: 568-73.
5. Leke R. J. I., Awah P. K., Forgwei G., Amin M. Complications of abortion
and post abortal care in rural district hospitals in the Centre and South
provinces of Cameroon. HS & D 2000: 2 June.
6. Leke R.J.I. Reproductive health of adolescents in sub-Saharan Africa, In
sexuality and reproductive health during adolescence in Africa, with
special reference to Cameroon. Pg 255-260, 1989.
7. Nji-Ako, Mbu R.E, Nana P., Tonye R., Eteki N., Leke R.J.I.
Early
pregnancy complications among adolescents admitted in the Central
Maternity of the Yaounde Central Hospital, Cameroon.
Journal de la
SAGO, 2003, vol 4, N°1 P. 26-30.
8. Leke R.J.I., Nana P., Gebresselassie H.M., Kimathi N., . Proposal for a
National Assessment of the Magnitude and Direct Cost of Abortion in
Cameroon. December 2007. (Unpublished study).
Page 18 of 18