Is LARC for everyone? Sociocultural perceptions and barriers to contraception among refugees in Ethiopia: preliminary findings

Abstract

Objectives: Ethiopia is home to more than 400000 refugees. Short-acting (oral contraceptives injectables and emergency contraception) and long acting contraceptives (LARC) are free to refugee women. However few women use LARC. The purpose of this study was to explore sociocultural perceptions of and barriers to contraceptive use with a particular focus on LARC. Methods: Qualitative data were collected in four Ethiopian refugee camps from January to February 2014 including: 12 focus groups (eight with women four with men) 10 interviews (all women) and 15 key informant interviews with contraceptive providers. Data were translated to English transcribed verbatim and coded by two coders. Salient themes endorsed across interviews are reported. Results: A common theme articulated by both men and women was having a reproductive plan including: number of desired children ideal birth spacing awareness of contraceptive methods and partner involvement in family planning. Participants’ plans were supported by their cultural norms and religious beliefs regarding contraception. Thus while they desired large families participants wanted contraception because it provided economic stability given their refugee status. Additionally participants wanted religiously sanctioned contraceptive methods (particularly Muslims) which were used primarily for birth spacing. Overall women felt satisfied with short-acting methods and unintended pregnancy appeared uncommon. Women reported a high rate of infant and child mortality. Conclusions: For Ethiopian refugees short-acting methods are preferred over LARC even when all methods are free. Although women relied on short-acting contraceptives unintended pregnancy is rare and women achieve their reproductive plans. For this population cultural and religious beliefs determine contraceptive selection and uptake. Copyright © 2014 Elsevier Inc. All rights reserved.