Barriers to contraceptive use in humanitarian settings: Experiences of South Sudanese refugee women living in Adjumani district, Uganda; an exploratory qualitative study.

INTRODUCTION: Contraceptive use can be lifesaving, empowering and cost-effective for women and girls. Access to contraception is still challenging to female refugees due to several barriers including language, low educational level, lack of information, influence by family members, limited income, cultural and religious norms. This study explored barriers to contraceptive use among South Sudanese refugee women living in Adjumani district, Uganda. METHODS: An exploratory study design using qualitative methods were employed involving women of reproductive age (15-49 years). Purposive sampling was used to select participants for Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) from three settlements in Adjumani district. We conducted four FGDs, each consisting of 8 participants. We also conducted fourteen in-depth interviews (IDIs) with women of reproductive age. The IDI and FGD guides were translated into local languages before they were used to collect data. The interviews were recorded, transcribed verbatim and translated into English. Audio recordings were labeled before being translated back to English. Deductive, team-based coding was implemented, and a codebook developed. Transcripts were entered, and data coded using Atlas ti version 14. Data were analyzed using content analysis to produce the final outputs for the study. RESULTS: The study found several challenges to contraceptive use. These included gender dynamics, socially constructed myths on contraceptive use, cultural norms, limited knowledge about contraceptives, men's negative attitudes, antagonism of contraceptive use by leaders and reprisal of women who use contraception. CONCLUSION: The study concluded that there is need for community strategies to break down the barriers to contraception utilization among refugee women. Such strategies should involve men and women alongside gatekeepers to enhance sustainability.

Factors associated with family planning use among refugee and host populations in Adjumani district, West Nile, Uganda: a comparative study.

INTRODUCTION: Uganda currently hosts an estimated 1.5 million refugees. The refugees have challenges in accessing family planning (FP) services in the host country. The study aimed to investigate factors associated with FP use among host and refugee populations in Adjumani district, Uganda. METHODS: A comparative cross-sectional study was conducted in May 2021 in three refugee settlements and their host communities in Adjumani district. A total of 1,310 respondents, (664 refugees and 646 host) were randomly selected using multistage cluster sampling and interviewed. Quantitative data were collected using structured questionnaires and analyzed using STATA V.15. Descriptive and Multivariate analysis performed. RESULTS: We found that modern Contraceptive Prevalence Rate (mCPR) was 30.2% (32.2% for host and 28.2% for refugees). Multivariate analysis showed that women who live singly (AOR = 2.25, 95%, CI: 1.56 -3.84), completed primary education [AOR = 1.65, 95% CI: 1.27-2.16], acquired skills [AOR = 2.28, 95% CI: 2.11-2.47], have the desire for another child [AOR = 3.73, 95% CI: 1.45- 9.60], have stayed in the study area between 3-5 years [AOR = 2.24, 95% CI: 1.46-3.42] were statistically significantly associated with FP use among both refugee and host populations. The key barrier to FP use by host was harassment of women and separation/divorce for not consulting the family members. Whereas amongst the refugees, they do not want to use FP methods. CONCLUSION: Our findings revealed low FP use amongst both populations in Adjumani district. The main factors associated with FP use amongst refugee populations included marital status, level of education, type of occupation, and duration of stay in the study area whereas amongst the host is the marital status. Main reasons for not using FP methods included fear of side effects by hosts and not wanting to use FP by refugees. There is need to sensitize both communities about the benefits of FP at community level.