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Cameroon.

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:

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

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

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

d) 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.

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

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

g) 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 Centres.

In addition to these are mission hospitals and private individual clinics and hospitals, such as Shishong Hospital in Nso, the Bingo Baptist Hospital in Bamenda, with an Annex Mutengene, Acha-Tugi Hospital in Mbengwi, with annexes in Baffoussam (West Province) and Limbe (in the South West Province) Solidarity Clinic in Molyko, Buea, Mount Mary Maternity in Buea, Good Shepard Clinic in Molyko Buea, Ebanja Clinic in Tiko, the Cameroon Development Cooperation Hospital in Tiko, Mary Health of Africa Hospital in Fontem and the Ad-Lucem Hospital in Banka-Bafang, with annexes in Douala and Bafoussam. Despite Cameroon's effort to improve health care, the number of health clinics offering family planning services is very small and the majority of those that do are located in urban areas. Act No 90/035 of 1990, prohibits birth control propaganda, limits women's access to information to enable them choose a contraceptive method thus isolating their rights under Article 12 and 15 (1)(b) of the International Covenant on Economic, Social and Cultural Rights (ICESCR).

The Cameroon woman has been enshrined with basic reproductive rights, although these rights are either not known to her due to ignorance, or trampled upon, due to cultural beliefs and practices or religious barriers. The rights enshrined within the 1996 Constitution, are as follows:

* The right to have sex when she wants

* The right to be pregnant when she wants

* The right to deliver, when she wants; where she wants, method of delivery and number of children she wants;

* The right to reproductive health education such as family planning, menopause;

* The right for a legal abortion

* The right to use maternal health care facilities;

* The right to use Antenatal, post-natal and infant welfare facilities;

* The right to stop her reproduction at her convenience;

* The right to choose and accept a sex partner of her choice;

* The right to participate in collective decision-making and implementation in reproductive health.

* The right to participate in health promotion programmes in reproductive health such as Cervical Cancer Screening, Breast Cancer Screening.

SRHR have evolved and continues to evolve, particularly, with the intervention of the Ministry of the Promotion of Women and the Family (MINPROFF) and the Association of Cameroonian female Lawyers (FEEDER) and some NGOs like CEDEF (Convention sur L'Elimination de toutes le Forme de Discrimination a L'Egale des Femmes), Association des Femmes de Bana. Services that are specialized in sexual education for young girls are not fully developed in Cameroon. Nevertheless, campaigns to sensitise the youth on the need to use contraceptives and particularly, on abstinence, are conducted all over the country through seminars, workshops and the media. Fliers and bills are posted in University Campuses.

2.2.1. Pregnant Women and nursing mothers

The findings from the Demographic and Health Survey in Cameroon (DHSC-III 2004) indicate that Maternal Mortality is high and is estimated at 669 deaths per 100,000 live births whereas it was 430 according to DHSC-II 1998. The constant high mortality rate is mainly explained by poor control of pregnancy, poor monitoring of labour and management of emergency obstetrical care, low contraceptive prevalence, upsurge of STIs/HIV/AIDS, Tuberculosis and Malaria. (Roadmap for Reproduction of Maternal and Neonatal Mortality 20062015, pp21-28).

The goal of the Roadmap is to contribute to the achievement of the MDGs by improving maternal health and the health of the newborn. The general objective of the Roadmap is to speed up the reduction of maternal and neonatal mortality by 50% before 2010, and 75% by 2015 with respect to the current level. Other specific objectives are:

* To make available and affordable quality maternal and neonatal care at all levels of the system in 70% of health facilities before 2015.

* To build the capacity of individuals, families and communities on the management of their health problems.

The government launched a Risk-Free Maternity Initiative, following the first conference for Risk-free Maternity that was held in Nairobi in 1987. The set objective was to reduce maternal mortality by 50% between 1990 and 2000. Unfortunately, the efforts made since the launching of the Initiative seem not to have produced the expected results. Faced with this situation, the government of the Republic of Cameroon has developed a Health Sector Strategy and a National Reproductive Health Policy to improve public health through improved availability of Quality Reproductive Health Services. The aim is to speed up the implementation of activities to reduce maternal and neonatal mortality as soon as possible (Roadmap for Reproduction, 2006-2015).

2.2.2. Family Planning

Government has raised considerable awareness on family planning. Through the Ministries, the government is training people, conducting media campaigns, organising seminars, workshops, and sensitisation on the importance of Family Planning. Condoms are distributed free during seminars and workshops and sold at relatively low cost in stores.

CAMNAFAW reports more than 76% of Family Planning cases from couples and 90% of women who seek Family Planning methods. CAMNAFAW is working towards changing the knowledge, attitudes and practices of women, couples, major traditional leaders, local councils and other agents towards Family Planning and increasing their reproductive choices from coercion and violence through a lot of Education and Workshops. Every general hospital has a Family Planning Unit.

In spite of these efforts, some lapses exist. Reports indicate that, although youths represent more than 30% of the population, only 7% practice family planning methods; only about 35% of adolescents know at least one modern method of contraception against 85% of their parents (NPRH, 2004). The utilization of modern methods is higher (13%) in urban than in rural areas (4.5%). Stereotypes over family planning are gradually fading away.

2.2.3. Infertile and Childless Women

The National Programme for Reproductive Health tries to prevent STDs and STIs; and has a chapter for childless mothers though it is not yet being applied. In the General Hospital in Yaounde for example, there is a centre for such women. There are no known government adoption agencies and even if some exist, the masses are not very informed about them. Orphanages owned by the private sector however may receive some grants from the government, but they are very rigid when it comes to the criteria that must be met before adopting a child.

There are reports that barren women are mocked. In fact, some women hold that a sterile woman is not a woman, and should not be considered as such. Others say that most sterile women must have committed crude abortions in their adolescent age. Others attribute it to illness such as Chlamydia.

Most childless women in Cameroon are treated as out casts. Some respondents (35%), attribute it to witchcraft either from the woman herself or from her family. The local people make statements such as "she has eaten all the children in her womb or has given them to her cultic societies". Another 10% contend that if a child less woman is legally married, her husband should be permitted to go in for a second wife who will bear him children.

There are no agencies to take care of such women. Nevertheless, the acceptance of these women in the society depends, primarily, on their own acceptance of themselves.

According to Mme Toutou (chief of service, Women's Affairs Unit, Douala IV urban council), if the woman feels dejected, rejected and lonely, the society may just accept her as such due to her behaviour; but if she feels comfortable and normal, and then she will socialise and, consequently, be accepted.

2.2.4. Aged Women/Menopause

Aged and menopausal women are women who have reached the end of child bearing, and some of who experience health complications, which make life difficult and sometimes unbearable. Reproductive health does not cease at this stage of ones life, however, the contrary is observed, taking into consideration, the treatment.

The Cameroon government has created special services at the Ministry of social Affairs to cater for the specific needs of old women- the Service for the Protection of the Elderly. There is a National Day for the Old on October 1st of every year. Several complications crop up with age and yet there are limited if any services.

With regards to the old women in Cameroon as a whole, existing structures to cater for their health and sexual needs are unknown or limited. Even when the old women become frail with complications such as hypertension, they struggle on their own or with relatives. Most of them live in the cities with their children or grand children, where they are taken care of especially in times of sickness.

Those who happen to be wealthy enough send their mothers abroad where specialised structures exist to cater for their needs. With the underprivileged, if remains a case of home care. But the poor and desolate ones, especially the childless ones either languish alone or are tossed from one relative to the other, where most often their rights are abused.

A good majority of the women however depend on farm work and consequently end up in the rural areas; either as widows or struggling with every bit of their energy to put food on the table for the family. When they go to hospital, they are treated as any other patient; having to wait for their own turn before seeing the Doctor without any consideration for their age and frailty with household chores.

2.3. Sexual Health and Rights

Sexual health is the ability to have a safe sexual life. According to United Nations, reproductive and sexual rights include rights to choose when to have children, the number of children, the right to health care facilities and services, the right to be informed about family planning, the right to sexual education. Some of the sexual rights of both gender, especially, the girl-child, such as the right to chose her sex partner (husband), right to chose when to have sexual intercourse, freedom to use contraceptives (e.g. condoms) or not and many others are often violated.

Some of the sexual health issues that are associated with the rights of the woman include STIs and HIV/AIDS; infant and forced marriages; Domestic violence and sexual abuse; education of the girl-child; early pregnancies and abortions; and Female Genital Mutilation (FGM).

2.3.1. STDs/STIs/HIV/AIDS

About 45% of women infected with gonorrhoea are asymptomatic. Almost 75% of women who consult for infertility have once suffered from chlamydia trachomatis; and with laboratories capable of diagnosing the mycoplasms, numerous cases are recorded (NPRH. March 2004).

The 2004 Demographic and Health Survey showed that the general HIV/AIDS prevalence rate is 5.5%. Women have a higher rate (6.8%) than men (4.1%). Out of a population of 16,322,000 inhabitants, an estimated510,000 children and adults live with HIV/AIDS(470,000 adults aged 15 to 49 years; 290,000 women aged 15 to 49 years and 43,000 children aged 0 to 14 years). There is an estimated 46,000 deaths due to AIDS and 240,000 orphans (under 17 years). (Brochure of the Cameroonian Chapter of the Alliance of Mayors and Municipal Leaders, AMICAAL, on HIV/AIDS in Cameroon, May 2007).

The first cases of AIDS in Cameroon were observed in 1987. Some asymptomatic HIV positive cases had been traced prior to that year. In December 1987,12 out of 168 Yaounde prostitutes (7%) were HIV positive. (Women's Reproductive Rights in Cameroon, a shadow report, CRLP 1999). Women are more likely to contract HIV through sexual encounters, and about 42% of all persons infected with HIV are women (United Nations Department of Public Information, February 1997).

The North West, East and South West Provinces lead in HIV/AIDS prevalence in Cameroon. The 2004 prevalence statistics show that the North West, East and South West had prevalence rates of 8.7%, 8.6% and 8.0% respectively. The provinces with the lowest prevalence were Far North (2%) and West (4%).

According to a doctor keen on HIV/AIDS matters and a member of DARVIR, 90% of HIV/AIDS transmission is through sex-homosexual or heterosexual, and only 10% through blood and mother-to-child transmission ("The Post Magazine" internet release, November 6, 2005). An on-going search indicated an alarming 9% seropositivity among medical personnel in Yaounde (NPRH, 2004).

The Cameroon government has adapted the following strategies to address the increasing HIV/AIDS prevalence:

* Setting up of Local Control Committees in the communities to ensure community participation

* Provision of free screening tests at all levels and mass screening campaigns. Free testing is available to children aged 0-15 years; persons with disabilities; pregnant women and prisoners. Others pay a token fee of 500frs for testing.

* Conducting awareness and sensitisation campaigns through advertisement, media (Television-CRTV, STV-radio, newspapers, books, and IEC materials. There is use of community radios to reach interior regions of the country. -The government has introduced free drugs to identified AIDS patients. This free-drugs strategy was lunched on the 1st of May 2007 at L'hopital Centrale, Yaounde

* The government has embarked on training personnel to take care of HIV/AIDS patients through workshops, seminars and in-service training

The following services are available for the treatment of HIV/ AIDS patients:

* Primary health centres located at the local/village levels, secondary health structures located at the district hospitals, and the provincial hospitals; there are private centres such as Centres for Prevention and Voluntary Screening (CPVS) and the Approved Treatment Centres (ATC), Chantal Biya Foundation (where PMTCT was started) and mission hospitals across the country that take care of HIV/AIDS patients.

* The government provides funds to the National AIDS Control Committee and targets pregnant women and women of childbearing age. HIV/AIDS testing is encouraged. IEC materials to sensitise the population are produced and distributed. Condoms are distributed free to the public.

2.3.2. Infant and Forced Marriages.

Different laws govern matrimonial cases in Cameroon. Therefore, the word early marriage is considered relatively. The diverse (200) ethnic groups have different value systems that operate along side the laws of the land. In essence, the Laws governing marriages in Cameroon stem from both statute and customary laws. The Cameroon law clearly states the legal age for entry into marriage as 15 and 18 years for women and men respectively (Ordinance No 81-02). Under age marriages and those without the consent of one or both parties are considered null and void by the law.

On its part Customary law once held that a child could be betrothed "dans le ventre de sa mere" (in its mother's womb). This proves the fluidity of the majority age for marriage under customary law. Parents are able to marry off their children at a very early age. Nevertheless, the practice of child betrothal seems to be ebbing away, with an emphasis on whether or not the girl child has attained puberty, usually characterised by the onset of menstruation. As for the boy, emphasis is laid on whether he has some ability to fend for a family such as fetching and selling wood, tapping wine or owning a farm. However, the absence of an age limit permits arbitrariness, and it is thus not uncommon to find girl children in abusive relationships in the name of marriage. The laws governing marriages in Cameroon are in conflict and in cases where there is conflict between Customary and and statutory law the provisions of the latter prevail. However, tradition is deeply roofed and therefore change is resisted.

Nevertheless, a common illegal marriage practice called "cohabitation" exists in the Cameroonian society and is widespread in small towns. Rural areas however depend more on traditional weddings and care less about the court and the church. Marriage is sealed once the bride price is paid.

This practice encourages forced marriages and is common in places where the girl child or woman is almost defenceless before her obliging parents. Those who try to protest end up being tortured and maltreated, and most of them don't know where to report their case. They receive threats of disownment from their parents. Among the Fulani and some other Muslim-related tribes it is still a common practice to have a female child betrothed right inside her mother's womb.

The media, the Human Rights Commission and other Non Governmental Organisations are disseminating information against the practice. In June a radio announcement on the issue of a man of 40 years who wanted to forcefully marry a 12 years old girl in the northern part of the country, spurred the government's intervention and the man was jailed under hard labour. This has prompted the government to set up Human Rights Commission offices in all 10 provinces of the country.

In Cameroon, both statutory law and custom discriminate against married women. The husband manages the property. The wife cannot exercise her rights over her own property without his consent, and is considered part of her husband's "inheritance property" in that she can be bequeathed and inherited by his heirs. The minimum legal age to enter into marriage is 15 for women and 18 for men; an age difference that is discriminatory and isolates adolescents rights to the provisions of Articles 10, 12, 13, 14 and 15 of the covenant (ICESCR). In addition, early marriage is still practiced in some rural areas.

The provision of free basic education is one of the strategies put in place to discourage early marriages. In some places like the North and Far North provinces where the Muslims practice early marriage of the girl child, institutions for basic education have been doubled to eradicate the practice. Furthermore, sensitisation campaigns are being carried out on the dangers of early marriages, especially for the girl child. There is some indication that more young girls are better informed on where to get information or find help.

Section 52(4) of the Civil Status Registration Ordinance of 1981 states that "No marriage may be celebrated where the consent of the spouses to be is not obtained. Lack of consent renders the marriage void." Sections 65(1) and (3) of the Ordinance further provide that the civil status registrar shall not celebrate a marriage if the consent is obtained by force or duress. Under Section 356(1) of the Penal Code, whoever forces or compels anyone to marriage shall be punished with imprisonment of 5 to 10 years including a fine.

2.3.3. Domestic Violence and Sexual Abuse

Cameroon seems to have a culture of violence. Payment of bride price makes the woman to be regarded as the property of the man. Domestic violence and sexual abuse are a violation of women's SRHR. Sexual abuse could be incestuous, rape, or pedophilia; where as domestic violence is the torture that goes on within the family--husband battering the wife or vice versa, father beating children thus leaving scars, or plain torment, which could include psychological and emotional strain/stress and abandonment.

Domestic violence is widespread in Cameroon but is not prohibited by law. The theory of the husband's "disciplinary rights" regarding his wife denies a woman's most fundamental rights, including her right not to be subject to violence or to cruel, inhuman and degrading treatment or torture (Article 5, Universal Declaration of Human Rights).

There is no law prohibiting sexual harassment. The "Rights of the Boss" which gives him nearly complete impunity in sexually harassing female subordinates, is a severe problem for Cameroon women and represents a clear violation of their rights under the provisions of Article 6 and 7 of the Covenant (ICESCR). Sexual abuse exposes many women to reproductive health problems.

There are no laws that protect the woman from assault and marital rape. Even where the law permits an intervention by social workers, it must be with the consent of the woman. Yet most women are either too shy to stand and proclaim that heir husbands rape them, or to say that their husbands cheat on them.

An example is the incident of a 9-year-old orphan girl who was picked up by her aunt; married to a' 60-year-old university lecturer in Douala. This man perpetually raped and consequently disfigured the young girl such that she no longer walks properly. A neighbor alerted social workers of this situation. The girl's aunt claimed ignorance of the situation and denied the violations and assured social workers that the problem had been solved at family level. It was later discovered that the woman had called her cousins and together they imposed a fine of 200,000 FRS CFA on the husband. It's not clear whether the child was ever taken to the hospital.

2.3.4. Education of the Girl-child

Literacy levels have an impact on the reproductive and sexual health and rights of women, not withstanding the hindrances posed by the laws and operative machinery, within the society and its institutions.

Where as education at the primary level is said to be free, many families can not afford the required schooling materials and other basic school needs, in addition, the distance to schools is another limitation. Cultural norms continue to give priority to boys' education because girls are expected to marry.

Educating boys is favoured, and the girl child is looked upon as a source of revenue given bride price. This practice still exists in some cultures of the North and Extreme North (Furaawa), some tribes in the South West and the Wum people of the North West Province. The government has instituted the policy of "Education for all and the promotion of the girl-child" which respondents suggest has helped increase the number of girl-children in schools. There is a higher drop out rate from secondary schools for girls than boys, with a retention rate of 54.6% for girls and 76% for boys, while in technical secondary schools, an appreciable 41% are girls with a greater retention rate in comparison to boys (CEDEF, 2006). The figures for female enrolment are very impressive at the university level, with a high percentage enrolling into the six state universities. University of Buea (49.9%); University of Douala (38.8%); University of Dchang (36.1%); University of Ngaoundere (26.7%); University of Yaounde 1 (39.1%) and University of Yaounde 11 (42.1%) with an average of 38.8% female enrolment.

Meanwhile, sex education remains a taboo subject, in most homes and in schools, and information related to reproductive health is relatively inaccessible to adolescents. The near neglect or absence of sex education opens room for sexual harassment to prevail with impunity on the streets, homes and work place; yet there is no law prohibiting the act, in clear terms. The "Rights of the Boss" which encourage sexual harassment of female subordinates, is a severe problem for Cameroon women and represents a clear violation of their rights, under the provisions of Article 6 and 7 of the Covenant. Indeed, the Act No 92/007 of August 14, 1992, which provides for complete freedom to enter into employment contracts, has had unfavourable effects on women, notably in the private sector. In fact, when a woman with equal skill is hired for the same job as a man, she is paid less. This discriminatory practice violates women's rights under the provisions of Articles 6, 7 and 10 of the Covenant, ICESCR (CRLP, 1999).

2.3.5. Early Pregnancies and Abortion

The low contraceptive prevalence in Cameroon has been associated with early, unwanted, close and numerous births. Although the findings from the 2004 DHSC show that among women of childbearing age, more and more women are getting to know contraceptive methods (90% in 2004 against 80% in 1998), with a higher proportion for modern methods (90% in 2004 against 81% in 1998) against about 69% for traditional methods, teenage pregnancy and its resultant effects on abortion rate and others, leaves an inalienable mark in the society, even though these figures are not reported when talking on maternal and neonatal mortality (see the Road Map for the Reduction of Maternal and Neonatal Mortality 2005-2015). Girls commit abortion; either because of poverty, the man who impregnates them denies responsibility, fear of parental reaction, and the quest to complete their education.

About 20 to 40% of maternal mortality is as a result of abortion; about 70% of recorded cases of abortion in hospitals are provoked, which indicates the failure of family planning. While exact data on the incidence of abortion is not available, the prevalence rate is about 35%. At the principal maternities, 40% of septic abortions emanate from adolescents, the high-risk group in family planning.

The promoting factors of illegal abortion, as Yurika Raymond stated, is the deficiency observed in the implementation of sanctions as stipulated by the law. Even though such statistics are indicative of fact, nobody would want to come out and accept that his or her hospital practises it. Secondary research revealed that government hospitals abort babies that endanger the lives of the mothers as well as pregnancies emanating from rape (with the consent for the mother). Other cases are reported (though inadequately) where the doctor only requires payment Traditional doctors perform very risky and illegal operations.

Cameroon's abortion law permits abortion only for therapeutic reasons or for pregnancy resulting from rape. Abortions are accepted in situations where the child and/or mother are at risk and not due to the socio-economic factors outlined above, yet no structures and services are made available where social workers, psychologists, counsellors and trained psychiatric nurses can provide counselling services.

The Cameroon law (in principle) punishes Abortion, under section 337 of the New Cameroon Penal Code of 2006, as stipulated below:

* Section 337(I) states that " Any woman procuring or consenting to her own abortion shall be punished with imprisonment from fifteen days to one year or with a fine of from 5000 to 200,000F CFA; or with both such imprisonment and fine."

* Section 337(11) states that who ever procures the abortion of a woman, not withstanding her consent shall be punished with imprisonment for from one to five years and with a fine of from 100,000 to 2,000,000F CFA."

* Section 337(111) states that the penalties prescribed by Section 337(11) above shall be doubled where the offender

a) Engages habitually in abortion.

b) Practices the profession of Medicine or an allied profession.

* Section 337(IV) states that in the circumstances of Section 337(111) b) above, the court may also order closure of the professional premises and impose a band on his occupation under sections 34 and 36 of the Penal Code.

There is a high incidence and prevalence of illegal abortion in Cameroon, and the cases that are hardly reported, make a mockery of the law and does not lend credence to futuristic policies and finding better solutions because the numbers are not known. Abortion is stated as being the source of 40% of obstetrics and gynecological emergency admissions (Ako and colleagues), with consequences, which include (a) increase infant and maternal mortality, (b) use of illegal and unprofessional health care facilities, with high risk of infections, death and other complications.

2.3.6. Female Genital Mutilation

FGM is a form of sexual violence, an act inflicted upon a woman (be it a girl) by another woman. In Cameroon, all forms of FGM are practised: Clitoridectomy, Excision and Infibulation. In the past, the operation was done with special traditional instruments; but today the general tendency is to use modern instruments such as razor blades, with the possibility of using the same blade on several persons, with dire consequences.

The practice is carried out mostly in the North, Far North, Southwest, West and East Provinces and there is no fixed age at which it is done. Female Genital Mutilation (FGM) was a common practise in the ancient times, including the 1970's, performed by the South Westerners of Manyu Division and the Fulani of the North as well as the Dschang people of the West. A lady in Dschang was punished with imprisonment for six years because she carried out the practice on her daughter in law, and this ended the practice in the West province. The main reason for the practice was to stop the girl child from being promiscuous and consequently preserve her virginity till marriage. This practise soon became an economic activity, yielding income to the perpetrators. In the Far North Province, the act is generally performed on girls who are between 3 to 10 years old, but there are cases where girls of 2 years as well as those above 10 years were mutilated.

A study carried out in the Ejagham Community found that old women with poor sight carry out FGM. This defect, coupled with the resistance of some of the victims, leads to cuts in other organs; mostly the vagina walls, the urethra and the bladder. Use of non sterilized instruments often leads to infections such as tetanus and septicaemia. It also brings about death in cases of severe bleeding. Sometimes the wound refuses to heal and in addition to the pain, during and after the exercise, formation of fistula and scars such as dermoid cysts as well as kelpies have a painful effect, during intercourse. This was suffered by 90% of the 30 circumcised women out of a random sample of 130 women, in astudy (Ekuri, 2005). The socio-psychological effects were just too atrocious, sometimes leading to suicide attempts. To date, excised women have the tendency of making out physical complaints and suffer from psychological problems such as depression and inferiority complexes, similar tosexually abused women. Yet, the Chief of Ejagham and five of his elders attested that no difference had been realised, in the level of promiscuity, between circumcised and uncircumcised women, a factor held paramount in performing this act.

In spite of advocacy against FGM by the Cameroon Government in collaboration with other women's associations and NGO's, there is no law prohibiting FGM, despite the health implications and the fact that it violates the woman's rights to full enjoyment of sex.

Women who carry out FGM are being introduced to alternative income generating acitivities. Television and Radio programmes that educate on the subject are being introduced both in national and private stations. Media programmes are also used to broadcast life testimonies of victims.

3.0 GENDER-BASED BARRIERS TO NEGOTIATION

3.1.1. Social Barriers

Social barriers to negotiation and free enjoyment of women's SRHR can be grouped into five main aspects: ignorance, fear and lack of courage, physical dominance as well as background and positioning of the husband, the fear of losing the man and the financial status of the woman.

Barriers established by the law: Act No 90/035 of 1990, prohibiting birth control propaganda, limits Cameroonian women's access to information to enable them choose a contraceptive method and thus isolates their rights under Article 12 and 15 (1)(b) of the International Covenant on Economic, Social and Cultural Rights (ICESCR).

Cameroon's abortion law, which permits abortion only for therapeutic reasons or for pregnancy resulting from rape also, has serious consequences for women's reproductive health. Clandestine abortion is very widespread in Cameroon and is the source of 40% of obstetrics and gynecological emergency admissions.

The minimum legal age to enter into marriage is 15 for women and 18 for men; an age difference that is discriminatory and isolates adolescents rights to the provisions of Article 10, 12, 13, 14 and 15 of the covenant. In addition, early (prior to age 15) and marriage is still practiced in some rural areas. Domestic Violence is widespread in Cameroon and is not prohibited by law. The theory of the husband's "disciplinary rights" regarding his wife isolates a woman's most fundamental rights, including her right not to be subject to violence or to cruel, inhuman and degrading treatment or torture as the case may be (Article 5, Universal Declaration of Human Rights).

3.1.2. Cultural Barriers

Cultural Practices and History: Cultural barriers are manifest in traditional practices. In many Cameroonian cultures, the woman is warned never to oppose her husband or make him angry. In the Ewondo tribe for example (Centre Province), a man can only prove that he loves his wife when he beats her up once in a while. The women have been brought up with that mentality and accept it as normal; seeing it as violence only when it results in maiming or deformation. The general trend in Cameroon however is that the man reserves the right to discipline his wife once in a while. One woman said, "A slap or two to discipline a wife is acceptable". (Women and Law in Sub-Saharan Africa, 2003)

Barriers to Family Planning: The traditional method of family planning (sending the woman to go and live with the man's mother until the child is about two years) is detrimental because it paves way for the man to be promiscous. This contributes to STI transmission.

Some cultures, for example, the Moslems, especially, those of the Northern region prevent their women from going out to public places. This retards the fast flow of information in such areas and since the majority of those who contract the disease are women, they remain ignorant. Some cultures consider blood sacred and can not thus give blood samples for testing.

The Practice of Polygamy: In almost all Cameroonian cultures, polygamy is permitted (especially for title owners like chiefs); but no Cameroonian culture permits polyandry; and the woman has little or no say in decision-making. Although the Sharia recognises an offer of marriage called "ljab" and an acceptance by the woman called the "qubul", girls are often withdrawn from school and forced into marriages they do not consent to; sometimes even as second wives. Actually, the culture looks upon a woman as inferior to a man in most aspects. A married woman for example owns her property; but is permitted to dispose of only one third of this property without the consent of her husband.

3.1.3. Religious Barriers

A multiplicity of religions exists in Cameroon, all playing a role on the reproductive and sexual health and rights of Cameroonians, either positively or negatively. To facilitate reporting, Cameroonians shall be grouped here into the Islamic and Christian groups.

Islamic Barriers: A good proportion of the population is made up of people who practice the Islamic religion. The peculiarity of this religion, in relation to reproductive and sexual health and right of the woman is of concern. First of all, Islam permits polygamy. Findings show that the Sharia does not sanction the delegation of authority to a husband to control two-thirds of the wife's property; and a decision by the Cadi (authority in an Islamic Court) to assign the control of two-thirds of a woman's property to her husband may not be challenged. This is yet another attempt by men to legitimise the subjugation of women by using Religion (Grant and Kuenyechia, 2003). The findings show that, the sharia does not specify any age at which a male or female can contract a marriage; but Urwa narrates that, the Prophet Mohammed ... contracted marriage with his wife Aisha, when she was only six years old and consummated the marriage when Aisha was only a nine year old child. This has very serious implications on decisions relating to child marriages, as the Cadis always quote from the Haddith or the Quran to substantiate their decisions (Grant and Kuenyechia, ibid). This conflicts with government's age limit of 15 and 18.

Christian Barriers: Christianity considers fornication and adultery as evil . Further more, most churches still have controversial views with regards to contraception and birth spacing in families. The Christian doctrine holds that children are from God and should be accepted when they come. Doing anything to avoid them when they come (e.g. committing abortion) or trying to regulate their coming should be considered as a sin punishable by God. Christians generally don't believe in exposing marital and family problems. Thus most Christian women having marital and family problems keep silent and practice the 'take-it-to-the-Lord-in-prayer' method of handling the problem.

Cranist and Ancestral Barriers: There exists a third group of Cameroonians, interwoven between the first two groups, whose religious attachments are not necessarily to one God, but mainly to small gods as well as ancestors. Some call them "cranists" (worshipers of ancestral skulls) and others call them traditionalists. The cranists depend entirely on what ancestors or the gods say through juju priests and traditional fortune tellers. The messages are sometimes hostile to women.

3.2 Constraints

There are no equipped and staffed reproductive health facilitiesln most rural areas, the people trust and depend on their traditional midwives who are experienced but rather unskilled. There is no programme that integrates these traditional midwives or even provides for their training.

In trying to reduce the spread of HIV/AIDS in Cameroon, the government has been encountering the following problems:

* Difficulties in reaching out to the people in the interior in order to deliver drugs and condoms on time. This is mainly due to inaccessible roads

* The lack of qualified and trained personnel in the rural areas, most of the trained personnel concentrate around the cities, where all the amenities are present.

* Many Cameroonians do not listen to take information on HIV/AIDS seriously with some denying the existence of the disease.

4.0 CONCLUSIONS AND RECOMMENDATIONS

4.1. Conclusions

While the findings indicate the steps taken by the Cameroon government to protect and promote women's SRHR there is need for more concrete strategies and actions to be taken. SRHR are restricted by culture and [dagger] cultural practices; stereotypical ideas; religious barriers; gender biased laws; inadequate and/or non-utilization of available health services; inadequate communication infrastructure; and absence of sustainable social services to cater for the expressed needs.

The government has made some strides in providing the necessary structures and renovating all the general hospitals in the country to meet modern standards, put up clinics in various districts of the country, encourage private hospitals and clinics to operate in all parts of the country, improved family planning, maternal and infant mortality,, controlled the spread of HIV/AIDS to a minimum degree, through its sensitisation and awareness messages. The lapses are equally glaring. Women are still ignorant of the presence of services, services are still beyond reach, the sexual rights of women are still determined by a minority few, and the political will is too weak, if not absent.

Regarding the legal framework, where as some laws do exist, such as the law on family planning, the law on infant and forced marriages and bride price, the law on abortion, the constitutional law on the protection of the elderly, the findings have shown that some of these laws are not respected, therefore exposing the woman to a continuous deprivation of fruitful enjoyment of SRHR.

On the cultural and religious barriers, the multiplicity of cultures makes it difficult for even the best conceptualised policies to be implemented. As a result, while early and forced marriages are, supposedly, a thing of the past the prevalence in some cultures notably among Muslims (the Mbororos of Sabga, the people of the Far North, precisely Kousseri) and some parts of the North West Province (the Widikum and Wum people for example), impacts on government's commitment to protect and improve women's SRHR. Yet it is women that promote some of these cultural norms, in some cases. Stereotypical attitudes have had an adverse effect on the eradication of some problems facing women. Meanwhile other women promote domestic violence, terming it the rights of a man to discipline his wife, for example among the Ewondo tribe of Yaounde, in the Centre Province.

Education and training especially of the rural women needs to be emphasised. Most training seminars and workshops on issues such as SRHR have focused more on the educated and urban woman.

There are notable gaps in the use of: radio, television, fliers, magazines, books and research (internet browsing and others) to convey SRHR messages. These gaps exist between those who can read and write, those who have televisions and radios, those who are inquisitive to notice fliers and notices and the majority that are totally and completely illiterate,-ignorant and poor and therefore oblivious to their surroundings and happenings.

On the part of government, there is lack of follow-up on and implementation of projects; poor decentralization of its structures and having them functionally equipped with data, human resources and equipment; limited exertion of a more stringent political will, punishment of culprits in conjunction with the existing laws and putting more efforts in ameliorating the health and welfare of its citizens.

Lack of information and poor communication undermines the enjoyment of SRHR.

4.2. Recommendations

Based on the findings and conclusions drawn from the research, the following is postulated as policy recommendations for reproductive and sexual health and rights.

4.2.1 Intervention by Government

On the ICPD, government has made some strides but has not respected the terms of the commitment fully. Even though the strategic Plan of the Roadmap spells out government's intentions for the period 2006-2015, and the proposed strategies emphasize on improving the health services, they exclude social services, which by implication denotes that the health sector still regards only the physical health of the patient and pays less attention to other social aspects.

Emphasis should be laid on providing counseling services that utilize social workers, psychologists, psychiatrists and counselors in the promotion and protection of the woman's reproductive and sexual health and rights. Gynecological facilities must be complemented by social services, if women have to enjoy their health and rights. An effective and sustainable counseling unit has to be instituted in every general hospital and clinics.

Men need to be educated on the fact that post-natal care is not only the woman's affair, but requires the attention of both father and mother. The government should establish structures that follow up the health of nursing mothers, and not just concentrate on the child as is the case presently. There is need for services to cater for the needs of elderly women

There is need to reinforce awareness-raising programmes and to reintegrate sex education into schools and communities. There is need for specific laws on domestic violence and sexual abuse. Companies need to institute measures against sexual harassment and abuse and sensitise both old and new employees on these Laws should also be put in place to avoid unequal treatment of women with respect to employment and wages.

The law stipulates the legal age for entry into marriage by males and females is 18 and 15 years respectively. The 1996 Constitution enshrines the right of the child to education. Yet, the same government allows for legal marriage at the tender ages stipulated above. At 15, how much education, skills and experiences must the girl have attained to enable her enter into a matrimonial home and start a family. In a situation where she is married to a boy of 18, what experience, skills and opportunities must have the boy attained at this age.

The cultural practices of some ethnic groups like the "Mbororos", some tribes in Wum of the Northwest Province and the people of Wabane in the Southwest Province of giving their daughters into marriage at very early ages violate the SRHR of the girl-child. We therefore propose that the legal age of marriage be revisited and modified, if Cameroon government is committed towards the protection and the promotion of SRHR of its citizens. Additionally, the government should implement an aggressive sensitisation campaign and training to educate and create partnerships in an effort to modify and eventually eradicate negative cultural practices. Forced marriages should be absolutely prohibited.

A law should be legislated to out law FGM since it not only violates the fundamental rights of a woman, but also inflicts pain and results in physical deformation. Programmes should be instituted to emphasize on the importance of women's right to education.

Finally, the government should create and fund research programmes.

4.2.2 Communities:

At the community level, the main actions should be geared towards raising awareness of the masses on women's rights and structures put in place to protect these rights.
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Title Annotation:Reproductive & Sexual Health Rights in Cameroon, Egypt, Ghana, Malawi and Rwanda: An Advocacy and Communications Approach
Author:Ngeve, Rebecca Eposi
Publication:Femnet News
Article Type:Report
Geographic Code:6CAME
Date:Jan 1, 2008
Words:8851
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