Prevalence and factors associated with uptake of modern contraceptives among South Sudanese refugee women of reproductive age in Bidibidi settlement, Yumbe District.

Abstract

Introduction: Accessibility of contraception is a fundamental human right and essential in the refugee settings. Globally there are 26.4 million refugees and 80% of them constitute women and children. However over 61% of the refugees are below 18 years. Women in refugee camps are prone to sexual violence and are at significant risk of pregnancy-related deaths due to the inaccessibility of adequate reproductive health services.

Data from the UDHS show modern contraceptive prevalence of 19.0% in West Nile region which hosts mainly South Sudanese refugees against the 35% for the country which is way below the reported figure of 13% in Bidibidi refugee settlement.

Objectives: The aim of the study was to determine the prevalence and factors associated with uptake of modern contraceptives among South Sudanese refugee women of reproductive age in Bidibidi settlement in Yumbe district.

Methods: A cross sectional study employing both quantitative and qualitative methods of data collection was conducted. Questionnaires were administered to 350 respondents who were refugee women of reproductive age, 15-49 years of age who had lived in Bidibidi settlement for the last six months preceding the study and were selected through a simple random sampling technique. A total of 10 key informant interviews and 11 focus group discussions were conducted. The quantitative data analysis was conducted in STATA using Pearson chi square test and Fisher’s exact test then followed by logistics regression while qualitative data were analysed using thematic analysis.

Results: The mean age of the respondents was 26.8 (SD=6.5 years) with median age of 26.5. The contraceptive prevalence for any method was 35.7% (95% CI: 30.7%-41.0%) with contraceptive prevalence of modern contraceptive use at 27.7% (95% CI: 23.08%-32.72%) and unmet need for family planning at 39.4% (95% CI: 34.27%-44.76%). The adjusted analysis revealed that women who were not employed (AOR, 0.37; 95% CI, 0.16-0.83) and had last had sex more than 3 months ago (AOR, 0.38; 95% CI, 0.22-0.67) were less likely to use modern contraceptives. In addition, women who had not heard about family planning were less likely to use modern contraceptives ((AOR, 0.10; 95% CI, 0.13-0.76) and less likely to have unmet need for family planning (AOR, 0.37; 95% CI, 0.15-0.87) while women who attained secondary level of education and above were twice more likely to use modern contraception (AOR, 2.04; 95% CI, 0.77-5.36), P= 0.045.

The qualitative analysis identified other barriers to modern contraceptive use that included; socio-cultural factors, lack of partner support, promiscuity, fear of side effects, limited access to services and myths and misconceptions.

Conclusion: The results showed that modern contraceptive prevalence was low with high unmet need among refugee women of reproductive age in Bidibidi settlement. The study found that women with no employment and those having last had sex more than 3 months ago were less likely to use modern contraceptive while those that had not heard about family planning were both less likely to use modern contraceptives and also had an unmet need for family planning. Targeted interventions should be put in place to increase modern contraceptive use and reduce unmet need for family planning in Bidibidi refugee settlement by addressing the identified barriers.