Barriers and facilitators to contraceptive use among Somali immigrant women in Oslo: A qualitative study.

BACKGROUND: The European Action Plan for Sexual and Reproductive Health emphasizes the importance of improving access to contraceptive services for disadvantaged groups. However, a prior study showed that the prevalence of abortion is two times higher among refugees compared to non-immigrants in Norway. Similarly, a recent study reported that 50% of Somali women in Oslo had unintended childbirth on one occasion or more. These findings are supported by several studies in Europe that showed immigrant and refugee women have higher rates of unintended pregnancy and abortion than Non-immigrant women, and more than half of immigrants, who seek abortion are not using any form of contraception, raising concerns about their access to utilization of modern contraception. However, none of these studies have explored reasons underlying immigrant women's underutilization of modern contraception. The present study aimed to explore the barriers and facilitators to contraceptive usage among Somali immigrant women in Oslo area. METHODS: A qualitative study using unstructured in-depth interviews with twenty one Somali women of reproductive age, >18 years, was conducted in Oslo from May-August 2018. The participants were recruited using purposive sampling method. Interviews began with a general question and were followed with some probing questions, and were continued until data saturation was reached. Data were analyzed using thematic analysis. RESULTS: Although the majority of the participants were educated, aware of the importance of contraceptive methods and interested in child spacing, systemic and socio-cultural barriers were found to be hindering their access to contraception. Several barriers were identified, including: language problems, lack of adequate information, religious beliefs, gender roles and social pressure. CONCLUSION: Eliminating the barriers which prevent women from receiving their desired form of contraception will have important public health implications, including lengthening inter-pregnancy intervals, and fewer unplanned pregnancies and abortions. These findings can support policy makers, civil society organizations and health providers to develop cultural sensitive programmes and educational interventions, which help Somali immigrant women overcome the identified barriers to contraception.

Sick and solo: a qualitative study on the life experiences of people living with HIV in Somalia.

BACKGROUND: HIV stigma and the resultant fear of being identified as HIV-positive can compromise the effectiveness of HIV programs by undermining early diagnosis and antiretroviral treatment initiation and adherence of people living with HIV (PLHIV). In the wake of the longstanding conflict in the country, little is known about the life experiences of PLHIV in Somalia. METHODS: A qualitative study using unstructured interviews was conducted in Somalia from September to December 2017. A convenience sampling approach was used to recruit 13 participants, including 10 persons who live with HIV and three senior officials who work for the HIV program at the Ministry of Health. Data were analyzed using a thematic analysis. RESULTS: Our findings show that PLHIV are alienated and prefer to isolate themselves due to widespread stigma subjected to them by their family members, society, employers, and health providers, which continue to undermine the scale-up of testing and treatment of PLHIV in Somalia. Consequently, they are reluctant to seek voluntary diagnosis and treatment of HIV. They often come to know about their status when their partners are found HIV positive, they are tested for other clinical purposes, or when an individual's health deteriorates, and all other means fail to work in improving his/her situation. The study also pointed out a shortage of facilities that provide HIV diagnosis, counseling and treatment in Somalia. CONCLUSION: Addressing stigma and discrimination subjected to PLHIV are critical to a successful HIV response in Somalia. To successfully address stigma, HIV programs need evidence on effective interventions at individual, community, and societal levels in order to strategically incorporate stigma and discrimination reduction into national HIV programs.