Young Women and Burden of Unsafe Abortion: 2023 Estimates from Two Hospitals in Yaoundé, Cameroon

OBJECTIVES: Adolescent girls and young women (AGYW) are particularly vulnerable to unsafe abortion (UA). The study aimed to describe the distribution of women with complications of abortions, determine the frequency of complications and deaths, and estimate measures of disease burden in 2023 at two hospitals. STUDY DESIGN: The study employed a cross-sectional design, utilizing retrospective hospital record review, and lasted 12 months. We included all recorded cases of abortion complications managed at two referral hospitals of Yaoundé in 2023. Data on all complications of abortion, live births, and maternal deaths were collected and used to make estimates for the incidence of infertility due to UA, based on recognized assumptions in the literature, and to calculate disability adjusted life years (DALYs). RESULTS: We identified 324 cases of complications of abortion in 2023; 235 were declared spontaneous abortions (SAs) and 89 (27.5%) UAs. Adolescents and young women (AGYW) accounted for 60,7% of UAs. There were 15 deaths (Case-fatality 16,900/100,000) in the UA group and none in the SA. The UA mortality ratio (per 100,000 live births) was 174. The proportion of maternal deaths due to UA was 16.0%. DALYs were 738.16 (Equivalence: 8,567/100,000 livebirths). CONCLUSION: UAs were very common, especially among AGYW, and associated mortality was high at the study hospitals in 2023. They contributed to a great proportion of maternal mortality, and the associated DALYs for 2023 are substantial. There is a need for a nationwide assessment and to improve access to contraception to reduce unwanted pregnancies, address stigma to favor timely consultation, and improve the quality of management.