Knowledge and attitude of schoolgirls about illegal abortions in Goma, Democratic Republic of Congo

Background: Adolescent sexual activity, early pregnancy, induced abortion and the increase in HIV infection have become major concerns in sub-Saharan Africa and understanding adolescent sexual behaviour remains a challenge. In the Democratic Republic of Congo (DRC), the practice of illegal abortions is prevalent among school-going adolescent girls with unplanned pregnancies. Assessing their attitude and knowledge on the subject could be a starting point from which to address the problem. Objectives: To determine the knowledge of schoolgirls in Goma, DRC about the health consequences of illegal abortions and to assess their attitude towards these abortions. Method: A descriptive cross-sectional study was conducted among a randomly selected sample of 328 high school girls aged 16 to 20 years. A pre-tested, self-administered questionnaire was used for data collection. Nine out of 55 (11 public and 44 private) secondary schools were randomly selected for inclusion in the study. The Epi-Info 2000 computer program was used for data capturing and analysis. Results: The different sources of information were the radio (66.2%, 217), friends (31.7%, 104), parents (1.5%, 5), and the church (0.5%, 2). The health consequences of illegal abortion mentioned were death, infertility, infection and bleeding. Of the participants, 9.8% (32) had committed an abortion before and 46% (151) knew where to obtain it; 76.2% (250) of participants were against illegal abortion, while 23.8% (78) supported it. Conclusion: Girls in secondary school in Goma had good knowledge of the illegal abortion practice and its consequences. A fifth of them were in support of the procedure. The DRC government may need to consider legalising abortion to secure a healthy future for affected girls. Vol. 2 No. 1 Page 1 of 5 INTRODUCTION It is estimated that 46 million abortions are performed each year, 20 million of which occur in countries where abortion is prohibited by law.1 Adolescent sexual activity and pregnancy are alarmingly common in many countries.2 Premature sexual intercourse results in high incidence and prevalence of adolescent pregnancy and abortion and also increases the risk of sexually transmitted infections and, as such, adolescent pregnancy needs careful and proper monitoring to ensure a safe outcome.3 Despite the social and cultural importance of child bearing in African society, unwanted pregnancies are a source of problems within the family. This is more acute for adolescent girls who often fall pregnant out of wedlock. Resorting to abortion is commonly their only choice if they wish to avoid facing judgment from their family and community. In Bendel State, Nigeria, attitudes concerning the desirability of abortion were assessed in a survey of 1 805 male and female secondary students. The study showed that, although abortion is still illegal in Nigeria, illegal abortions involving adolescents are widespread, with Catholic students expressing a greater opposition to abortion than protestant students, or those from other religious backgrounds.4 Abortion is still illegal in the Democratic Republic of Congo (DRC), except when the life of the mother is in danger. The DRC is a country where the majority of the population practices Catholicism, a religion that discourages all forms of contraception and condemns the termination of pregnancies. Mortality and morbidity associated with illegal abortion have been found to be significant in urban areas such as Goma.5 Adolescents represent a significant proportion of the women who choose abortion. The World Health Organisation estimates that at least 33% of all women seeking hospital care for complications related to abortions are under 20 years of age.6,7 Because illegal abortions have high mortality and morbidity rates, legalising abortion is a highly debatable issue among health policy makers worldwide. This study sought to assess the level of knowledge and attitude towards illegal abortion amongst secondary school girls in Goma, DRC. METHOD A descriptive study, using a pre-tested, self-administered questionnaire that had been developed by the research team, was chosen to assess the knowledge and attitude of schoolgirls in Goma about illegal abortion and its consequences. The study population comprised high school girls in Goma aged 16–20. The study population was chosen because it was found to be a high-risk group for unwanted pregnancies and requests for termination of pregnancy.5,8 Both the public and the private school sectors were recruited. Participants were randomly selected; a list of all high schools in Goma was obtained from the provincial inspector of primary and secondary education. There were 55 (11 private and 44 public) secondary schools with fifth and sixth forms in Goma. The town of Goma is divided by three main roads into three sections, with an even distribution of the schools. Although the schools were categorised into the private or public sectors, all the pupils lived in the same town, with almost the same social and cultural norms. Additionally, Original Research Paluku, Mabuza, Maduna & Ndimande PHCFM http://www.phcfm.org A fri ca n Jo ur na l o f P rim ar y H ea lth C ar e & F am ily M ed ic in e