Trends in medical termination of pregnancy by adolescents in calabar, Cross River State, Nigeria

Background: Most adolescents, especially those that are sexually active are aware of the risk of having unprotected sex. As a result there are many unintended pregnancies and illegal termination of pregnancies contributing to a high maternal mortality and morbidity ratio, which seems to indicate a large unmet need for contraceptive use or a deliberate attempt not to use any method for reasons known to those in need. Dilatation and curettage or other surgical methods of termination of pregnancy had been popular over the years until recently. Contraceptive use among adolescents is low in spite of high level of awareness. There are various modern method of contraception in use and currently prevalence rate for contraceptive use in Nigeria is approximately 11%–13%. This rate is very low in spite of the high rate of sexual activity and widespread awareness of the various contraceptive methods among Nigerian adolescents and youths. Objectives: Most adolescents who require contraceptive do not make themselves available at public health facilities for proper counseling, mostly for fear of victimization and also not to appear to be seen as a prostitute. The use of medical method of abortion is usually done in the privacy of the patient but unfortunately it may become public knowledge when it becomes incomplete or complication arises. This survey aims to ascertain the knowledge and practice of self induced medical abortion among adolescents in Calabar and the outcome of the procedure. Methodology: This was a questionnaire –based prospective study carried out at the University of Calabar Teaching hospital and the General Hospital, both in Calabar metropolis. The informations were obtained from adolescents who presented with bleeding per vagina and a history of attempted medical termination of pregnancy. Those who used surgical or combined methods were captured in the study but further analysis was focused on those who attempted medical abortion only. Information collected included age, source of information, method of abortion and type of medication used. Results- A total of 236 of the 328 female adolescents who presented with history of attempted abortion using medications were recruited into this study. Their age range was16 to 19years, with a mean age of 17.5years. The respondents have all attained basic primary education and above. Some were still in school but all have heard about contraception or family planning. 124(52.5%) admitted to using both oral and vaginal Misoprostol (Cytotec), 86(36.4%) used Misoprostol in combination with Mifepristone while 26(11.1%) used local herbs combined with local hot drinks (ogogoro or kie kie) mixed with Aspirin tablets. Conclusion: Approximately 90% of adolescents (in this study) easily access pharmacies or chemist shops (by extension in Nigeria) and purchase any drug they need including regulatory drugs without prescription, as long as they are ready to pay for it. Misoprostol has become a common drug in the hands of adolescents in procuring abortion unlike dilatation and curettage (D&C) which previously was the method of choice. Many adolescents have bled to death while concealing a termination of pregnancy because in the majority of cases the treatment they administer hardly ensures complete abortion.