Cameroon.

• Author: Ngeve, Rebecca Eposi
• Position: Reproductive & Sexual Health Rights in Cameroon, Egypt, Ghana, Malawi and Rwanda: An Advocacy and Communications Approach - Report

1.0 BACKGROUND AND INTRODUCTION

1.1 Study background

The 1994 ICPD in Cairo and the 1995 Fourth Conference on Women held in Beijing expanded the right to family planning to include the right to better sexual and reproductive health. The goals of the action plan were, for the most part, reaffirmed in the United Nations Millennium declaration. Cameroon agreed to implement the Programme of Action of the ICPD, in the domain of Reproductive and Sexual Health.

1.2 Objectives of the Study

1.2. I. General Objective

The general objective of this research is to assess the implementation by the Cameroon government of the International Conference on Population and Development (ICPD) and other relevant international and regional instruments, such as the International Covenant on Economic, Social and Cultural Rights (ICESCR), to ascertain the progress made on women's SRHR in Cameroon.

1.2.2. Specific Objectives

Specifically, the current research attempts to:

1. Examine the progress Cameroon Government has made, towards the commitments to protect and guarantee women's reproductive and sexual health and rights.

2. Determine the achievement in the areas of reproductive and sexual health and rights.

3. Identify and describe the constraints experienced in its quest to redress these issues in order to track the implementation of the ICPD.

4. Determine the gender-based barriers (cultural and religion) and their impact on women to the negotiation and full enjoyment of women's reproductive and sexual rights by women.

5. Examine {and postulate} documented strategies aimed at redressing such barriers.

6. Recommend policies/laws and measures that can be amended or established to address such barriers.

7. Identify key messages, including those addressing cultural and religious barriers, for use at the local and national levels, during national campaigns.

   1.3 Background on Cameroon

   Cameroon is geographically diverse and predominantly agricultural. It produces coffee, banana, cocoa, oil palm, wood, rubber and cotton. Cameroon's ethnic and cultural situation is certainly peculiar, a peculiarity that covertly impacts on any well conceived policy. Socio-anthropological and linguistic studies show a diverse, noticeable, representation of the ethno-cultural groupings, ranging from 230 ethnic groups (Report of Treaty Bodies, 1998), 256 (Ethnologue, 2004) to 279 ethnic groups (Kuma'a Ndumbe 111, 1986; UNRISD, 2000), with 130 languages (Ethnologue, ibid.)

   While there are more than 200 ethnic groups each with a dialect, a multiplicity of churches do exist, with the main religious bodies being Catholic, Protestant and Muslim. Meanwhile, the political landscape since 1990, is characterized by multi-party politics with more than one hundred political parties registered in the country. The political system is heavily influenced by ethnicity and traditionally, tribes are powerful in decision-making, at the national level. Hence each tribe has an interest in increasing its population to avoid extinction. It is thus not surprising to see some tribes, like the Bamilekes having many children (1015), from one woman of childbearing age. Today, the country has ten (10) administrative provinces, fifty-eight (58) divisions, two hundred and sixty-five (265) subdivisions and fifty-three (53) districts (Ministry of Public Health, ibid.), with a population projection of 16,018,000 inhabitants, in 2003 by the Ministry in charge of Planning and regional development (World Health Report, 2005) or 16,322 000 million people (WHO, 2007).

   1.4 Scope of the Study

   The study is limited to the assessment women's SRHR specifically, Reproductive Health Care, Family Planning, Safe Motherhood and Abortion; (Article 12, 10, and 15 (1) (b) of ICESCR); Childless and Barren Women, HIV/AIDS and Sexually Transmissible Infections (STIs) (Article 12 of the ICESCR); Infant and forceful marriages (Article 10 of ICESCR); Sexual and Domestic Violence (Article 10 and 12 of the ICESCR); Female Genital Mutilation/Female Circumcision (FGM/FC) and Education (Articles 13, 14, 15, and 12 of the ICESR).

   1.5 Research Design

   The research covered four provinces namely: Southwest, Northwest, Littoral and Centre, with concentration on the urban towns of Buea, Bamenda, Douala, and Yaounde. Two main participatory methods were used for data collection; conversational interviewing, using a pre-prepared interview guide and documentary evidence.

   Research was conducted in a participatory manner bearing in mind the HeRWAI approach. A questionnaire was administered to the previewed sample of 200 respondents (group one), from the four provinces (50 each). A key informants interview guide was administered to the second category of persons including Provincial Delegates, Directors of Public Health, Gynaecologists and Medical Practitioners, Nurses, CSOs and the media.

   1.6 Selection and Choice of Institutions for the Study

   Target areas and potential sources of information included the Ministry of Public Health in Yaounde, Provincial and Divisional Delegations of Public Health, Women and Empowerment and Social Affairs, Hospitals and other public health facilities, Rural and Urban Councils (Cellule de L'Action de la Femme, Mairie Urbaine, Douala IV, Bonassamba--Douala) and individuals of all levels, such as teachers, farmers, housewives, business men and women, lawyers, uniform officers. The individual reports, opinions and documented facts as well as statistics, were compiled, presented and analysed to discover trends and patterns, and interpreted to come up with conclusions.

   2.0 FINDINGS AND ANALYSIS

   2.1. Baseline Information

   Before 1980, Cameroon was pro-natal, with a law (Law No 29/69 of 20-05-69) prohibiting the sale of contraceptives or any form of anti-conception publicity. Child spacing was practiced through prolonged breast-feeding (21 and 20 months), in rural and urban areas, respectively, without necessarily aiming at limiting the number of children (Leke, 1993).

   Legislation, family and birth allowances and reduction of taxes as a function of the number of children were in favour of increased number of children. But by 1976, the authorities started reflecting on the adverse effects of a high population increase on the economy and social life. In 1980, a Presidential policy speech officially mentioned the consequences of a rapid and uncontrolled population increase on employment, urbanization and health. Consequently, a national commission was set up which proposed the prescription of contraception.

   The efforts by the Cameroon Government to meet its ICPD obligations are contrasted by the fact that Cameroonians (approximately 80%) do not know or are not aware of the ICPD. On the implementation of the ICPD, a lot of time is required to accept its provisions. In 1999, a National Forum was organised by the Ministry of Public Health on Reproductive health, where the ICPD was recommended and after elaboration, some of the components of the ICPD were adopted for immediate implementation in Hospitals.

   Implementation tools were developed to handle the various components of reproductive health. All these tools were ready by 2005 and are expected to run up till 2010. Recent tools have also been adopted on child and maternal mortality (cited in the Roadmap of Public Health sponsored by O.M.S, UNDP, UNICEF, GTZ, and the French Cooperation) and actions, such as quality care during delivery, proper delivery, in some of the health units, and this is only being achieved with the help of partners.

   2.2. Reproductive Health and Rights

   Reproductive health has evolved almost parallel with the health system in Cameroon. The Primary Health Care (PHC) approach was adopted in 1982 and was re-defined in 1987, after the Alma-Ata conference with the aim of achieving the main objective, which was health for all by the year 2000. The District Health approach was also initiated. A Health District (HD) is a unit in which the community participates actively in the management of its health. Some examples are the Bokova and Bova Health Centres, respectively, in the BONAVADA community in the Buea District, as well as the Ndokovi Health Centre in Bafang and the District Health Centre of Bandja all in the West Province and the Mother and Child Welfare Centre, PMI Nkwen (Protection Maternelle et Infantile) in Bamenda. These Health Units are managed by the community's Health Committees, in partnership with the Ministry of Public Health.

   Given health problems, such as high maternal mortality, large family sizes, families delivering many children, increased prenatal and infant mortality rates, a sizeable proportion could not have children, pregnancy and delivery was considered a women's issue, few qualified personnel and pregnancies of young girls between 14 and 19; a few gynaecologists were promoted to reflect on reproductive health, which was then only concerned with mother and child. Female physicians later took up the challenge and, in the early 1990's; an association of female medical doctors in Cameroon ("Association Camerounaise des Femmes M6decin": ACAFEM) was formed. Its objectives are to bring together female physicians, promote research among members and evaluate health activities. Also, created in the early 1990s was the Society of Gynaecologists and Obstetricians of Cameroon (SOCOC). It meets every 3 months to discuss reproductive health issues and research projects and results.

   Cameroon has a public health sector, which is made up of central, provincial and district hospitals, and others in the following categories:

   * Category one: Two (2) General Hospitals and one (1) University Teaching Hospital, making three (3) in all

   * Category two: Two Central Hospitals, including one Para public, making three (3) in all.

   * Category Three: Ten (10) Provincial Hospitals; one (1) per province.

   * Category 4: One Hundred Thirty-Six (136) District Hospitals.

   * Category 5: Sub-Divisional Medial Centres, and

   * Category 6: Integrated Health...