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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.
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.
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, pupils in private and public schools study the same curriculum, as required by law.
A random sample was obtained, comprising 2 250 girls, aged between 16 and 20, across nine schools (seven
private and two public). A representative sample of 328 pupils was derived using a computer statistics software
package.9 In each of the selected schools, the girls in fifth and sixth form were assembled
in a large classroom
and provided with a participant information sheet that explained the purpose of this study. Each consenting
participant was then requested to sign the consent form. Questionnaires were administered either immediately after school,
or during break-time and each participant was required to complete the form in their classroom. Confidentiality was ensured
by using an anonymous questionnaire and requesting each participant to sit alone, to avoid influencing others. Completed
forms were collected by the principal investigator and the research assistant.
The data were captured and analysed using the Epi Info 2000 statistical programme. The study was preceded by a pilot
study comprising of 72 respondents from three schools - one public and two private. These respondents were subsequently
excluded from the main study. The pilot study assisted in refining the questionnaire.
Approval to conduct the study was granted by the Research, Ethics and Publications Committee (REPC) of the Medical
University of Southern Africa (MEDUNSA), now known as the University of Limpopo (Medunsa campus) in South Africa - Clearance
Certificate Number: MP 14/2003.
Knowledge and sources of knowledge about the health consequences of illegal abortions
In order to assess the participants' knowledge of illegal abortion, we focussed on the concept of abortion itself,
personal experiences (or those of others), the legal implications for abortion in the country, and its influences
on an individual's health.
The results regarding the meaning of abortion saw that 61.3% (201) participants knew what abortion meant,
22.6% (74) did not, and 16.1 % (53) were unsure. In relation to personal experience, 9.8% (32) of the participants
had had an abortion before, 96.9% (31) of whom had induced it, while only one had had a spontaneous abortion; 77.1%
(253) of the participants knew someone who had committed an illegal abortion, 22.6% (74) did not, while 0.3% (1) was unsure.
The different sources from which they obtained information about abortion-related issues, were the radio (66.2%, 217),
friends or colleagues (1.7%, 104), parents (1.5%, 5), and the church (0.5%, 2). Additionally, 46% (151) of participants
knew how and where to obtain an abortion. Table 1 demonstrates the knowledge categories and the corresponding frequencies.
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Table 1: Knowledge about illegal abortion (n = 328)
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Table 2: Age and knowledge about illegal abortion (n = 328)
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Table 2 shows that the majority of the participants were 18 years old 32.6% (107/328), followed by the 19-year-olds
30.8% (101/328), the 17-year-olds 23.8% (78/328), the 16-year-olds 9.8% (32/328), with the lowest category being the
20-year-olds 3% (10/328).
The knowledge level among the girls increased according to their age across their respective age categories: 28.1% (9/32)
among the 16-year-olds, 80.8% (63/78) among the 17-year-olds, 87.9% (94/107) among the 18-year-olds, 96.0% (97/101) among the
19-year-olds, and 90.0% (9/10) among the 20-year-olds. Overall, the respective percentages of the girls who had knowledge about
illegal abortion according to age groups were 2.7%, 19.2%, 28.7%, 29.6% and 2.7%. The total percentage in this category was 82.9%.
Of the 328 participants, 249 (75.9%) knew someone who became ill after having an abortion. Most participants (83.2%)
knew some health consequences of illegal abortion, but 53 participants (16.1%) did not have knowledge of any health
consequence of an illegal abortion and two participants (0.7%) were not sure of their knowledge.
Figure 1 shows the knowledge of the schoolgirls about the health consequences of illegal abortion. Health consequences
mentioned were death (79.1%, 233), infertility (14%, 46), infection (2.5 %, 8) and bleeding (1.4 %, 5).
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Figure 1: Health consequences of illegal abortion
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Figure 2: Abortion consideration before and at time of study
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Attitude towards illegal abortion
While most of participants, 76.2% (250), were against illegal abortion, 23.8% (78) supported it.
Table 3 shows the reasons the participants gave in support or rejection of illegal abortion.
The two main reasons for the participants who supported abortion were unplanned pregnancy 9.5% (7),
and to prevent school disruption because the girl was still at school, 8.5% (6). The largest age-group
to support illegal abortion was the 18-year-olds, 12.2% (10). For those who did not support illegal abortion,
spiritual convictions 34.1% (85) and health problems 34.9% (87) were the main reasons identified. Illegal
abortion was almost equally rejected among the 17-, 18- and 19-year-old participants 21.8% (55).
Figure 2 shows that 10.7% (35) of the participants had considered illegal abortion in the past and 9.7% (32)
(data not shown) of these had committed an illegal abortion. This means that approximately one in ten
respondents had considered illegal abortion in the past. This figure also shows that more than double 24.4% (80)
of participants who had considered abortion before, would consider it if they were pregnant at the time of the study.
This means that approximately two in ten respondents would consider illegal abortion if found pregnant at the time of the study.
Knowledge of abortion
Across the world, abortion is very often morally defined. The percentage of participants who
knew the meaning of abortion indicated that the topic was well known in Goma too. In a study
conducted in Korea, it was found that the mass media had informed the public about several
sexual problems facing that country, including early sexual intercourse among the youth,
unwanted pregnancies and increased rate of induced abortions.10 According to the responses
obtained with regard to the sources of information on illegal abortion, the Goma community
uses mostly the radio to access information. This was supported by a study done in Kenya on
the knowledge and perceptions of abortion among adolescents.11
Our study demonstrated that parents (1.5%) and the church (0.5%) provide little knowledge
to girls on illegal abortion. Parents were also found to play a minor role in delivering
information on abortion to adolescents in the study done in Kenya.12 An explanation for the
limited church involvement in Goma might be that Catholicism is the dominant religion in the
country and is known to be conservative regarding sexual matters. On the contrary, the Catholic
religion was found to be encouraging education of adolescents about abortion in the Philippines.12
Regarding information from the household, it was found that teenagers received very little sex education
from their parents in Zambia,13 which could be due to the fact that talking about sex is often still
regarded as taboo in many African societies, including the DRC.
Experiential knowledge of abortion
Regarding the experience of schoolgirls on abortion, the study found that 9.7% of the participants
reported having had an abortion before, among which 96.9% of them had induced the abortion.
This proportion seems to be higher than the observation made in Nairobi, Kenya, where only 1.7% of the 1 751 adolescent schoolgirls - to whom a questionnaire had been administered about their
knowledge on reproductive biology, sexual behaviour and its relationship to contraceptive practice - admitted
to induced abortion.14 On the other hand, findings in this study were lower than those found in a
study conducted in Benin City, Nigeria, in which 160 respondents (30.2%) were reported to have committed an
illegal abortion.15
Because abortion was still illegal in the DRC at the time of the study (2003), many cases of abortion were
believed not to have been reported. It could therefore be inferred that the recorded figures were an underestimation.
The under-reporting of cases was in keeping with a study on sexual experience, knowledge, attitude and practice of
contraception, conducted among senior high school students in north Gonder, Ethiopia. In that study, 30.1% of sexually
active female students were found pregnant, among whom only 4.8% admitted to have committed an illegal abortion, whereas
the actual figure was most probably higher.16
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Table 3: Reasons for or against illegal abortion (n = 328)
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Knowledge about health consequences of illegal abortion
The study showed that three in five schoolgirls had knowledge about illegal abortion,
close to four in five knew someone who had committed an illegal abortion and also that
four in five were aware that it was illegal in the DRC. Therefore, the subject of illegal
abortion was not new among the participants. As abortion is a criminal offense in the DRC,
affected girls tend to procure it illegally, resulting in adverse consequences, as stated by
those who had known someone who had committed it before, including themselves.
Regarding the health consequences of illegal abortion, it was found that death was
the most mentioned consequence, followed by infertility, infection and bleeding. In his
article entitled Youth often risk unsafe abortions, Barnett identified infection, mortality,
haemorrhage and infertility as serious health problems associated with unsafe abortion. He showed
that because adolescents lacked the knowledge of where to go for a safe procedure, they were more
likely to become victims of these complications. Furthermore, in the same study, he found that the
risk of complications was higher for adolescents.6 Similar complications were reported in another
study on adolescents and abortion done in Dar-es-salam, Tanzania.17
It would be difficult to estimate the number of girls who die as a result of illegal abortions
in the DRC because no study has ever been conducted in this regard. Nevertheless, the WHO currently
estimates that there are 115 068 unsafe abortions undertaken daily across the world. About 95% of
these occur in the developing countries, such as the DRC, and lead to the deaths of more than
200 women daily.5,18 Complications of abortion
include infertility due to tubal damage, pelvic infection and chronic pelvic disease.19
Attitude towards abortion and its health consequences
Most participants (76.2%) were against illegal abortion, while 23.8% supported it.
The girls knew that it could lead to death, infertility, infection and bleeding.
Reasons given against illegal abortion were spiritual convictions, health reasons and personal preferences.
On the legalisation of abortion, our findings were almost similar to those found in Benin City,
where a significant number of the schoolgirls had resorted to illegal abortion as a solution to their unwanted pregnancy.
Nevertheless, in that study the percentage was slightly higher (30%) than the one in our study.15 In our study,
reasons given in support of the illegal abortion were the fact that the pregnancy was unplanned,
the girl was still at school, to avoid disappointing parents, and lack of proper resources to take
care of the girl and the baby during the pregnancy and after. In the DRC, abortion is only allowed on medical grounds,
that is, to save the life of the mother. Similar reasons for procuring an illegal abortion, such as
to avoid being expelled or forced to drop out of school, were given in the Nigerian study
mentioned above.15 In our study,
approximately one in ten of the respondents had considered illegal abortion in the past.
This study showed that more than double (24.4% vs 10.7%) of participants (80 vs 35 participants)
who have considered abortion before would again consider it if they were pregnant at the time of the study.
These findings suggest that the number of schoolgirls who would consider abortion is on the rise.
Previous studies have already demonstrated that abortion is becoming endemic, particularly among adolescents
who are attending secondary school.20 The WHO confirmed this by showing that sexual activity is increasing among
adolescents and by demonstrating that, in many African countries, up to 70% of all women hospitalised for abortion
complications are younger than 20 years old.5 As long as adolescents are involved in sexual activities,
they are at a high risk of becoming pregnant. Studies in Africa have found that accessibility to
family planning information and services is lacking.6,15
The schoolgirls of Goma, DRC had a reasonable knowledge of illegal abortions, their common source being the radio and friends.
Almost half of the respondents knew how and where to obtain an abortion; the other half were ignorant in this regard.
Most of those who have had an abortion had induced it. The majority of the girls knew that abortion was illegal in the country.
They also knew that illegal abortion could lead to death, infertility, infection and bleeding. However, in spite of their
knowledge about abortion and health consequences of illegal abortion, the willingness to consider abortion was found to be
increasing among schoolgirls in Goma.
The Congolese Government may need to consider legalising abortion to secure a healthy future for affected girls.
This study was conducted in partial fulfilment of the requirements for the award of the Master of Medicine (Family Medicine)
degree at the Medical University of Southern Africa (now the University of Limpopo, Medunsa campus).
1.Glenn M, Merz J. Abortion. Encyclopaedia; 2002.
2. Yang M. Adolescent sexuality and its problems. Ann Acad Med Singapore. 1995;24(5):736-740.
3.Creastas GK. Sexuality: Sexual activity and contraception during adolescence. Curr Opin Obstetric Gynecology. 1993;5(6):774-783.
4.Oshodin O. Attitude towards abortion among teenagers in Bendel State of Nigeria. J R Soc Health. 1985;10(1):22-24.
5.WHO. Safe motherhood: Address unsafe abortion. World Health Day, 1998.
6.Barnett B. Youth often risk unsafe abortions. Networks. 1993;14(2):12-15.
7.Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2000. 4th ed. Geneva: World Health Organisation; 2004.
8.International Clinical Epidemiology Network (INCLEN). J Adolescent Health. 1998-2001.
9.Department of Research and Administration. University of Limpopo [homepage on the internet]. No date [cited 2009 Sep 22]. Available from: http://www.ul.ac.za/index/php?Entity=Research
10.Kang BS. Adolescent’s sexual problems in Korea. Integration. 1990;(24):33-36.
11.Mutungi AK, Karanja JG, Kimani VN, Rogo KO, Wango EO. Abortion: Knowledge and perceptions of adolescents in two districts in Kenya. East Afr Med J. 1999;76(10):556-561.
12.Castro C, Palomar CY. Sex and adolescence. MARHIA. 1991;4(1):1, 3-5.
13.Pillai VK, Yates DL. Teenage sexual activity in Zambia: the need for a sex education policy. J Biosoc Sci. 1993;25(3):411-414.
14.Lema V. Sexual behaviour, contraceptive practice and knowledge of reproductive biology among adolescent secondary school girls in Nairobi, Kenya. East Afr Med J. 1990;67(2):86-94.
15.Oronsaye A, Odiase G. Attitudes toward abortion and contraception among Nigerian secondary school girls. Int J Gynaecol Obstet. 1983;21(5):423-426.
16.Fantahun M, Chala F, Loha M. Knowledge, attitude and practice of family planning among senior high school students in north Gonder. Ethiop Med J. 1995;33(1):21-29.
17.Silberschmidt M, Rasch V. Adolescent girls, illegal abortion and ‘Angar-laddies’ in Dar-es-Salam: Vulnerable victims and active social agents. Soc Sci Med. 2001;52(12):1815-1826.
18.Edelson E. Abortion numbers fall worldwide. US news and world report [serial online]. 2007 Oct 12 [cited 2009 Apr 13]. Available from: http://health.usnews.com/usnews/health/healthday/071012/abortion-numbers-fall-worldwide.htmv
19.Rogo K. Induced abortion in Sub-Saharan Africa. East Afr Med J. 1993;70(6):386-395.
20.Odejide TO. Offering an alternative to illegal abortion in Nigeria. New Era Nurs Image Int. 1986;2(2):39-42.
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