From the 1^st of November 2022 to the 31^st of May 2023, 169 cases of abortions were recorded for 1882 emergency consultations, giving an abortion frequency of 9.6%.

The average age of the patients was 27.98 ± 6.8 years with a range from 14 to 45 years. The most represented age group was 25 to 29 years (29.3%). Those single made up 3/4 of this population (75%). More than half (54.9%) had studied up to higher education. Moreover, 55 of them were housewives (33.5%) ( Table 1 ).

Concerning clinical data, multigravidas represented 44.6% of the study population, the average number of pregnancies was 3.2 ± 2.2 (range: 1 - 11). However, there were nulliparous women (38.4%) with an average number of previous term deliveries of 1.6 ± 1.3. The average gestational age at the time of termination of pregnancy was 12 ± 4 weeks of amenorrhea. Among these patients, less than a third (30.5%) had a history of abortion with an average of 1.9 ± 1.2 abortions (range: 1 - 5). In this population, 19.5% of patients reported having conceived under contraception, with the male condom as the most incriminated method in 56.2% of cases. Per-vaginal bleeding was the most common reason for admission (70.7%).

Nearly 75% of these abortions were spontaneous according to the patients. Regarding the induced forms, the fear of an unwanted pregnancy (46.3%) followed by the parent’s fear (21.9%) were the main reasons for recourse to abortion. In addition, the initial diagnosis of incomplete abortion was made in 70.7% of the patients.

Complicated forms were found in 75 of them (40.2%) with 44 in the group of spontaneous miscarriages and 31 in the group of voluntary terminations of pregnancy. The main complication was anaemia in 40.2% of cases. Two deaths (1.2%) were recorded among those who had undergone voluntary termination of pregnancy. This outcome resulted on the one hand from complications of genital bleeding and on the other hand from infection following intrauterine manoeuvers ( Figure 1 ).

Concerning emergency management, 96 patients (58.5%) benefited from uterine emptying by manual intra-uterine aspiration. However, for 2.1% of them, were managed by emergency laparotomy. After the implementation of medical measures, approximately 88.9% of patients benefited from post-abortion care (range: 60.4% - 100%). Only 31.7% of participants decided to use modern method of contraception before leaving the health facility ( Table 2 ). Of the remaining 112, 16% were formally opposed to the use of modern methods of contraception.

The frequency of abortions was 9.6%, higher than 6.9% found by Ajavon et al. [9] in 2018 in Togo. This difference may be due to the fact that contraceptive prevalence differs from one region of Africa to another. Indeed, contraceptive prevalence was 24% in Togo compared to 19% in Cameroon. However, Cameroon has made enormous financial commitments since 2014 around family planning, and among its objectives, an increase in contraceptive prevalence of 35% in 2030 constitutes the main target to be achieved. This low use of modern methods of contraception would expose to unwanted pregnancies, abortions and their complications [10] . However, 19.5% of patients reported having conceived under contraceptive methods. This finding is in line with the scientific literature, as Barjot et al. described cases of conception under oral contraceptive, with the main reasons being patient forgetfulness and stopping due to side effects which were mainly nausea and vomiting [11] . Three cases of pregnancy under contraceptive implant based on etonogestrel without identified risk factors have been described in the literature [12] . In view of these factual data, abortion could be seen as the response to poorly met needs for contraception by desiring women, or as the response to the failure of contraception among proven users. The average age of patients was 27.9 ± 6.8 years, similar to the result of Kamga et al. [7] who found an average age of 27.98 ± 6 years. This is a period of peak fertility per excellence in Cameroon according to Tebeu et al. [13] . Singles (74.4%), with a university education level (54.9%) were mainly concerned, in accordance with the results of Kamga et al. in 2017 [7] who mostly found singles (75%) with a secondary education level (62.5%) within his study population. The social and economic vulnerability of these groups could be a factor of exposure to unwanted pregnancies [14] . On the other hand, the study of Ajavon et al. in Togo in 2018 on the management of incomplete abortions in the first trimester at the CHR of Kara revealed that married patients (67.6%) and housewives (35.1%) were the most affected.

Bleeding (70.7%) was the main reason for consultation in the emergency room. This is consistent with the results of Fouedjio et al. [15] where bleeding was also found in 80% of cases. Bleeding and pelvic pain were the main symptoms of abortions, whether spontaneous or induced [16] . Spontaneous abortions represented 75% of the cases in our study, a result higher than that of Kamga et al. in 2017 who found 60% of cases of induced abortions [7] . Furthermore, 70.7% of abortions were incomplete, in accordance with the findings of Ajavon et al. [9] who reported 86% of incomplete abortions. During our study, the patients’ statements were the only source of information we had to classify the participants in a group, moreover in a context where abortion is illegal, patients with induced abortions only go to the hospital in the event of complications [17] .

The main reason for the patients’ refusal to keep the pregnancy was the unwanted nature of the latter (46.3%), which is consistent with the study of Fouedjio et al. [15] in which the main reasons were the unwanted nature of the pregnancy and/or the concern for birth spacing (62.5%). Unwanted pregnancy was also the reason given by patients (44.4%) in a study conducted by Mwetaminwa et al. [18] in 2018 in the Democratic Republic of Congo. These results further highlight the extent of the non-satisfaction of contraceptive needs in our society.

Fear of parental reaction (21.9%) and disagreement/separation from partner (4.8%) were also found among the reasons for abortion. In a society where talking about sexuality with one’s young daughter is taboo, the issues of premarital sexuality and indirectly abortion are not discussed within the family, so abortion may be quickly considered in the event of an unwanted pregnancy [19] . In Africa, married women believe that they need their husbands’ approval to use contraception, and very often their husbands will not consider returning to condom use once they have stopped; a wife’s insistence may be perceived as proof of infidelity [19] . As a result, many women categorically refuse to use a contraceptive method, exposing themselves to the consequences of unwanted pregnancy.

A method of contraception had been established in 52 patients (31.7%), a result lower than those of Fouedjio et al. in Yaoundé in 2019 [15] with 40.9% of users in urban areas and Kubaya et al. in Congo in 2023 with 40.3% of users in a rural area [20] . Although family planning has a high impact in reducing maternal mortality, many women do not adhere to it despite effective awareness-raising. Some would be opposed to the use of modern methods of contraception for fear of side effects, others for socio-cultural reasons in favour of natural methods of contraception [21] . To remove barriers to the use of contraception, we opted during the study to emphasize awareness-raising and communication with the various parties to listen and, above all, despite fears about contraception. Setting up mobile units is an important option if we are to reach the largest possible target group, as the problem of contraception is primarily a societal one [19] .