Mona Lisa Africa
Cameroon
JANUARY 2009
The Mona Lisa Programme in the Cameroon: Feedback from Dr Dongmo Roger - Gynaecologist and Obstetrician as well as Project Manager of the Passage Cameroon Project (Solidarity Approach in Health)
What is the situation in the Cameroon in terms of reproductive health and prevalence of contraception?
To start with, we found a high level of fertility at a young age on a national basis (138% at 15-19 years). This figure grows rapidly until the age of 20-24 years (236%) and of 25-29 years (231%). This is maintained at a significant level (194% at 30-40 years and 126% at age 35-39 years). Then, despite the availability of a wide range of contraceptive methods provided by a generic supply network at a reduced cost, the average percentage of women using modern contraception in Cameroon is very low, only 13% (2% in the town of Maroua). The male condom and the contraceptive pill are amongst the modern contraceptive methods most often used.
The extreme North of Cameroon, with around 5 million people, is the most densely populated area of the country. At the same time it is the poorest part of the country, with more than half of the population living below the poverty line. As contraceptive method, the injection is number one, followed by the Pill, the implant and the intra-uterine device (IUD).
How has the Cameroon become implicated in the initial phase of the Mona Lisa Africa programme?
It was due to the interest that the project Passage Maroua expressed in obtaining copper IUD's, that Cameroon became involved in the Mona Lisa Africa programme. Thus we wanted to make a contribution to:
- Improve the level of knowledge regarding the methods of contraception,
- expand the variety of choice of contraception methods (which is often restricted to injections at most of the health services in Maroua),
- make the accessibility to efficacious methods of contraception easier for the poor.
We also wish to respect the need for discretion regarding the women wanting contraception but who have opposition from the men.
What is the attitude of the local authorities?
The Passage project initiative is supported by the regional public health delegates responsible for the promotion of the woman and the family.
When at the traditional authorities, they benefit from the social mobilization activities conducted by the Passage project which includes advocacy for contraception.
Religious influence on healthcare can play an important role because IUD's are often associated with a ‘method of abortion' and are therefore not supported by these groups.
What part of the population is targeted by the Mona Lisa Programme?
All women of child baring age are targeted. Of the estimated 5 million inhabitants in Maroua, around 1 150 000 women fall in this category.
The city of Maroua itself is the hub of activity for the Passage project and the population here is around 350 000 of which:
- 80 500 are women of child baring age (15-49 years)
- 70 000 young ones (10-24 years)
What about the resources necessary to initiate the programme and to keep it going on track?
- The Maroua region consists of a structure that includes 28 health districts and 244 healthcare centres that provide modern contraception methods. The healthcare workers are all trained on the basis of Family Planning. For the training programme, the Passage project has the support of a partner... the Toulouse University.
- Amongst the planning centres that benefit from Mona Lisa IUD donations, 11 will be in possession of the kits needed to insert IUD's (i.e. a speculum, Pozzi forceps, examination lamp) provided by the Passage project.
- We also foresee IUD distributions outside of Maroua and for that we need to "recycle" the theoretical knowledge of the healthcare workers that are interested. We also have to arrange on site training. The Passage project will make a donation of kits for IUD insertion to the centres that do not have any.
- Regarding the population, an awareness campaign as well as community mobilization will be organized by the 8 partner associations of the Passage project.
What kind of follow-up is there for the women who receive an IUD?
Women will have a medical follow-up and a control within a month after the IUD was inserted and then again after 3 months. After this we visit them every 6 months, preferably after their menstruation period. We have a file of information that is obtained from the women who benefit from the Mona Lisa IUD.
As coordinating country, what are your concerns regarding the Mona Lisa Africa progamme ?
Introducing the IUD remains limited to the city of Maoua (hub of the Passage project) because of geographical reasons.
Some healthcare workers still have misconceptions about the IUD, while very few have seen it up close. Many women (even healthcare personnel) that have never seen an IUD still believe that the string hangs suspended between the legs and they have difficulty to imagine how normal sexual interaction can take place under such conditions.
But in saying this, I must also mention that the number of IUD's inserted in six months (July to December 2008) has almost tripled in number compared to 2007 and this gives us lots of confidence regarding increasing the numbers of insertions in this region.
The presence of free IUD's and the safety of the insertion method in new users, contribute to neutralize the ambiguity and to attract women who want a discreet method of contraception.
Awareness and community mobilization: a facilitator right there for the personnel of the Maroua authorities
Campain of mobilization and presentation of several contraception means during August 2008 summer holidays.
Double protection was highly encouraged, especially for young people. Nevertheless all contraceptive methods were presented, as well as places where they could be supplied.