Brenna Daly Health Research Lit Review

Running Head: CONTRACEPTIVE USE FOR REFUGEE WOMEN SUB-SAHARAN
AFRICA
EXAMINING THE FACTORS ASSOCIATED WITH CONTRACEPTIVE USE FOR
SUB-SAHARAN REFUGEE WOMEN: A REVIEW OF THE LITERATURE
Brenna Daly
University of Georgia
Fall 2021
HPRB 5010
CONTRACEPTIVE USE FOR REFUGEE WOMEN SUB-SAHARAN AFRICA
TABLE OF CONTENTS
RESEARCH QUESTION………………………………………………………..……………….2
INTRODUCTION……………………………………………………………………..………….2
Purpose…………………………………………………………..……………..………….2
Social-Cultural…………………………………………………………………………….3
Factors…………………………………………………………….……………………………….3
Partners’ Influence……………………………………………………………..………….4
Accessibility Factors…………………………………………………………………...….4
Contraceptive Perception………………………………………………………………….4
Factors………………………………………………………….………………………………….5
METHODS……………………………………………………………………………….……….5
Search Strategy & Data…………………………………………………………………..5
Resources…………………………………………………………….…..……………………….5
Inclusion Criteria & Selection of Studies……..………………………………..…………………6
RESULTS………………………………………………………………………………………….8
Study Samling & Design……………………...…………………….…………………….8
Religious Factors……………………………...…………………….…………………….8
Partners’ Influence…………………………………………………………..…………….8
Social-Cultural Factors…………………………………………………..…………….10
Accessibility Factors…………………………………………………..……………….11
Contraceptive Perception Factors………………………………………...……………12
DISCUSSION…………………………………………………………………………...……….13
CONCLUSION……………………………………………………………………….………….18
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REFERENCES…………………………………………………………………….…………….20
RESEARCH QUESTION: Which factors are associated with contraceptive use for sub-Saharan
Africa refugee women of reproductive age (15-49) in sub-Saharan Africa?
Introduction
In 2020, sub-Saharan Africa had a refugee population of around 6,658,149 (World Bank,
2020). South Sudan, Somalia, Sudan, Rwanda, Nigeria, Ethiopia, Eritrea, Central African
Republic, Congo Democratic Republic, Burundi, and Mali all had refugee populations of over
150,000 people (World Bank, 2020). Hosting over 80% of the world’s refugee population, there
is great pressure on Africa’s healthcare systems in these hosting countries (Africa Renewal,
2017).
While there is regional variety for contraceptive use in sub-Saharan Africa, overall
modern contraceptive use is on the rise. The most commonly utilized methods in this region are
implants and injectables. The rate of use is higher “among unmarried sexually active than
married females” (Tsui et al., 2017). Though the rates of contraceptive uptake are rising, there
are also high rates of discontinuation. These high rates of discontinuation, which means to
discontinue contraceptive use, is often attributed to experiencing side effects (Sato, et al., 2020).
Among the diverse population of sub-Saharan Africa, there are many barriers to
contraceptive use, especially among refugee women dealing with forced displacement. Forced
displacement is defined as displacement “as a result of persecution, conflict, generalized
violence, or human rights violations” (UNHCR, 2014). Cultural influences, social influences,
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religious affiliation, partners’ influence, accessibility factors, and contraceptive perception and
their effects on contraceptive use will be examined throughout this review.
Purpose
This paper will focus on factors affecting contraceptive use perceptions and uptake in
reproductive age (15-49) sub-Saharan African refugee women. More specifically, social-cultural
factors, religious factors, partner’s influence, accessibility factors, and contraceptive factors will
be addressed, as well as contraception utilization.
Social-Cultural Factors
The total fertility rate of sub-Saharan Africa between 2015 to 2020 was 4.7 births per
woman (United Nations, 2019). This rate is more than double the total fertility rate of any other
region. These high fertility rates reflect the preference for larger families and more children in
sub-Saharan Africa (Lightbourne, 1987; Westoff, 2010). These high fertility rates can be
attributed to a lower average age for women when getting married, low contraceptive use rates,
cultural norms, little access to education for females, and relatively high child mortality rates
(New Security Beat, 2015).
Religious Factors
A study conducted in Malawi found a variety of religious influences on family planning,
but no differences in contraceptive use between denominations. The majority of religious
leaders from all faiths were found to approve modern contraceptive use (Yeatman, S. E., &
Trinitapoli, 2008). Muslim and Pentecostal leaders were more supportive of family planning
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practices than Catholic leaders. Although, the contraceptive rate of use was higher among
Catholic women than Muslim and Penetcoastal women. From a wide scale approach, there is
little connection between the opinions of religious leaders on contraceptive use and the
contraceptive use of members. For specific congregations, the beliefs of individual religious
leaders had a strong association with the family planning behaviours of women in their
congregations (Yeatman, S. E., & Trinitapoli, 2008).
Partner’s Influence
The familial systems in sub-Saharan Africa are often traditional and patriarchal. Many
women do not seek out or consider family planning. They may feel that they do not have sexual
autonomy to make their own reproductive decisions, and that their husbands or other family
members take on this decision-making role (Haider & Sharma, 2013). A study on male partner
influence in South Africa found that opposition of male partners to contraceptive use contributed
to their female counterparts discontinuing contraceptive use or maintaining covert use (Kriel et
al., 2019). Male opposition to family planning methods was attributed to male dominance in
relationships, limited understanding about possible side effects (misconceptions on lessening
fertility and fear of negative side effects), and physical abuse (Kriel et al., 2019). Male partners
that supported family planning methods via shared responsibility, social support, and adequate
information were found to have positively influenced their partner's family planning/
contraceptive use uptake (Kriel et al., 2019).
Accessibility Factors
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In refugee settings, there may be a greater need for contraception, but access to
contraceptives and contraceptive services is often decreased (UNHCR, 2019). As these women
are displaced from their homes, added risks can occur: early marriage, forced marriage, increased
risk of sexual violence, disrupted social structures, disrupted family structures, education
interruptions, livelihood disruptions, and gender-based violence for refugee women (UNHCR,
2019). Generally, there are issues with service quality, provisions with certain types of
contraceptives, provider barriers, and supplies in refugee health facilities. Firstly, healthcare
providers can lack training and knowledge, have biases or predispositions, and have little
communication with patients about contraceptives due to “perceived sociocultural resistance”
(UNHCR, 2019). This “perceived sociocultural resistance” is due to the negative stigma
sometimes associated with contraceptives in sub-Saharan refugee settings. Furthermore, poor
service, long waiting times, poor hygiene, disrespect, lack of supplies, and lack of privacy often
exists in these facilities (UNHCR, 2019). There are also inadequate policies concerning
long-acting and permanent contraceptive options and lack of awareness about emergency
contraceptive methods (UNHCR, 2019).
Contraceptive Perception Factors
A major barrier to contraceptive use for women in sub-Saharan Africa was the
association of contraceptive methods with promiscuity and straying from one’s partner (Ochako
et al., 2015). Many women also have fears of possible side effects that can occur for birth control
methods. Fears of side effects, particularly for hormonal contraceptive methods, is a barrier to
use for African women (Blackstone et al., 2017). These feared side effects may include
infertility, cancer, weight gain, weight loss, menstrual irregularities, and prolong menstruation
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(Blackstone et al., 2017). This is often formed by misinformation or misconceptions, such as
certain methods, specifically injectables, causing infertility (Ochako et al., 2015).
Methods
Search Strategy & Data Resources
A literature review was conducted to examine factors and perceptions affecting
contraceptive utilization in refugee women of reproductive age in sub-Saharan Africa and those
displaced from sub-Saharan Africa. The University of Georgia Galileo Library Database
System’s Multi-search tool and Google Scholar were used in this research to find relevant studies
through a systemized search. The literature search addresses the following question: [1) Which
factors are associated with contraceptive use for sub-Saharan Africa refugee women of
reproductive age (15-49) in sub-Saharan Africa?
Inclusion Criteria & Selection of Studies
The studies selected for this literature review needed to meet the following criteria requirements:
● Available online
● Published between 2010-2021
● Scholarly (peer-reviewed)
● Published in English
● Published in academic journals
Research was not geographically restricted to countries in sub-Saharan Africa, but also
included countries where sub-Saharan refugees had settled after displacement. This research was
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accepted to allow analysis for different perspectives that may not be considered by those
currently living in sub-Saharan Africa. After applying the basic inclusion criteria, the selection of
articles involved reading through the first five pages of results for every search. Articles were
selected that appeared to be relevant to the topic of this research, with initial relevance based
upon article title. A preliminary review of the abstracts from selected articles was conducted to
determine if the study would help formulate an answer to the research question. Through this
search process, sixteen peer reviewed journal articles were found using different search
terminology. Another search utilizing Google Scholar with the same inclusion criteria and
process to determine relevance was conducted, yielding four peer reviewed journal articles. A
total of twenty articles were selected for this review.
Search Terms and Results that Determined Selected Studies
Table 1: Search terminology and results
Database Terms used Filters Number of Articles
Results Used
Search #1 UGA Library contraceptive Scholarly (Peer 199 #1, #2,
website, factors AND reviewed) #3, #4,
multi-search refugees Journals, #5, #6,
tool Format: Academic #7, #8,
Journals, Dates: #9, #10,
2010-2021
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Search #2 UGA Library reproductive Scholarly (Peer 89 #11, #14,
website, health AND reviewed) #20
multi-search refugee AND Journals,
tool Africa Format: Academic
Journals, Dates:
2010-2021
Search #3 UGA Library contraceptive Scholarly (Peer 354 #15, #16
website, use AND reviewed)
multi-search refugee Journals,
tool Format: Academic
Journals, Dates:
2010-2021
Search #4 UGA Library reproductive Scholarly (Peer 101 #17
website, health AND reviewed)
multi-search humanitarian Journals,
tool AND Africa Format: Academic
Journals, Dates:
2010-2021
Search #5 Google Scholar contraceptive Scholarly (Peer 20,400 #10, #13,
AND refugee reviewed) #18, #19
AND Africa Journals,
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Format: Academic
Journals, Dates:
2010-2021
Results
Study Sampling & Design
The studies utilized in this literature review had varying methods of sampling. Sample
sizes range from as small as 21 participants to as large as 5,468 participants. Many of the studies
reviewed had sample sizes of less than 200 participants and acknowledged small sample size as a
limitation to their study. Data collection methodology included mainly primary data, as well as
secondary data from research that was done previously.
The studies selected for review were qualitative, cross-sectional, with a majority of
studies being cross-sectional surveys. There is a research gap in the literature and more
longitudinal studies need to be conducted.
Religious Factors
Of the selected studies, six explored the relationship between religious affiliation and
contraceptive use. The research collected by these studies found that beliefs decide when one
should have children and how many children should be left to Allah, though some believed that
contraceptive use did not go against Islamic beliefs. Many women believed that their fertility
was decided by Allah and did not use contraceptives (Kiura, 2014; Gele et al., 2020; Davidson et
al., 2017; Zhang et al., 2020; Agbemenu et al., 2017; UNHCR, 2011; Agbemenu et al., 2020).
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Though, others believe that Islam allowed for contraceptive use for birth spacing and family
planning (Davidson et al., 2017; Kiura, 2014).
Partners’ Influence
Six of the selected studies examined the relationship between utilization of contraceptives
and partner’s influence. The overall results of these inquiries found that a woman’s contraceptive
use depended greatly on her partner’s support or consent (Seyife et al., 2019; Okanlawon et al.,
2010; Bakesiima et al., 2020; Gele et al., 2020). Rates of contraceptive use were found to be
much lower for women who made decisions about family planning jointly with their partners.
These rates were also lower when the decision was solely up to their partner, rather than when a
woman independently made the decision (Seyife et al., 2019). Women who were married or
cohabitating with a partner were more likely to use modern contraceptives than single women
(Okanlawon et al., 2010). Some women even mentioned that their partner would not allow for a
condom to be used during their sexual encounters (Okanlawon et al., 2010). The modern
contraceptive prevalence rate was significantly higher among women who had partners that were
students, compared to women with partners of other occupations (Bakesiima et al., 2020).
Partner’s age was also an influential factor. Husband’s support for contraceptive use increases a
woman’s use of contraceptives (Gele et al., 2020). Women even reported needing to be
accompanied by their husbands or having an authorization letter to be able to have access to
family planning services (Gele, et al., 2020).
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A major cultural influence was the custom of having a large family and not wanting or
feeling able to limit the number of children born (Casey et al., 2015; Royer et al., 2020). Many
women noted that they did not discuss the number of children they wanted with their partners
(Gele et al., 2020). Though some refugee women favored contraceptive use after seeing families
struggle with large family size and the ability to care for all their children (Gele et al., 2020).
Overall, contraceptive use was viewed as more acceptable when spacing out pregnancies, rather
than limiting the number of pregnancies (Royer et al., 2020; Agbemenu et al., 2017; Davidson et
al., 2017). Women also felt that using contraceptives was associated with risky sexual behaviors
outside of marriage (Kiura, 2014; Casey et al., 2015). The perception existed that modern
contraceptive methods were a Westernized phenomenon being perpetuated by developed
countries in order to control their fertility (Kiura, 2014; UNHCR, 2011).
The research examined found that lack of accessibility was a major barrier to
contraceptive use. A majority of refugee women were not aware of a contraceptive source within
a ten minute walk from their residences in refugee communities (Bakesiima et al., 2020). Women
who had contraceptive access at a convenient location were much more likely to use modern
contraceptives compared to women that did not have access to a convenient service site (Seyife
et al., 2019). Some women were not aware of a specific place where they could access
contraception, which can contribute to underutilization of these health services (Ganle et al.,
2019; Dauda, 2012). Women who were able to receive family planning counseling services were
over three times as likely to use contraception and much more likely to have an unmet need
(Seyife et al., 2019; Gebrecherkos et al., 2018; Vollmer et al., 2019). Health facilities in the
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camps that were assessed that were required to provide family planning services had enough
supplies, equipment, and faculty to be able to provide adequate services (McGinn et al., 2011).
One study even found that product theft by health center personnel was making these supplies
less accessible (Nara et al., 2019).
There are also many communication barriers between refugee women and their care
providers/facilities. Women sometimes felt uncomfortable having discussions with their
healthcare providers about contraceptives (Agbemenu et al., 2017). Refugee women surveyed
expressed that if health information given to them at health facilities was available in their native
language, there would be increased contraceptive uptake (Gele et al., 2020). One study also
found that family planning messages in the community were written in English, making it hard
for women that spoke a different language or that were illiterate to see these messages and form
an opinion (Kiura, 2014).
Furthermore, there are expansive supply-side issues that create barriers to contraceptive
use: lack of availability of permanent and long acting methods, few trained staff members at
health facilities, lack of authorization (Casey et al., 2015; UNHCR, 2011; McGinn et al., 2011).
Short acting family planning methods were offered more frequently (Casey et al., 2015).
A barrier to contraceptive use cited in a majority of the studies reviewed was negative
perceptions of contraception. The main reason for many refugee women not using birth control
was fear of side effects (Bakesiima et al., 2020; UNHCR, 2011; Kiura, 2014; Gele et al., 2020;
Agbemenu et al., 2020). Some of these health concerns included irregular bleeding, general pain,
stroke, reduced fertility, and lack of appetite for certain methods (Davidson et al., 2017). Heavy
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bleeding, and increase in weight were also cited as concerns among women that had previously
used birth control (Chi et al., 2015). There was also misinformation and rumors that
contraception causes irregular menstruation, bleeding, vitamin deficiencies and cancer in refugee
communities (Kiura, 2014; Gele et al., 2020). Many women were also misinformed about
contraceptive methods (Agbemenu et al., 2017). Health concerns and concerns about interfering
with the body’s normal processes were reasons for not using contraception (Okanlawon et al.,
2010). Some contraceptive methods were viewed as safer than others. Condoms were seen as
safer than other methods of birth control, such as oral contraceptives (pills), emergency
contraception,intrauterine device (IUD), injectables and implants (Okanlawon et al., 2010).
Though rate of condom use was low among refugee youth over concerns that it reduced sexual
pleasure, resulting in a condom not being used during sex (Okanlawon et al., 2010). Female
refugees were particularly concerned about long acting contraceptives, such as IUDs (Davidson
et al., 2017). A factor that increased uptake of contraception utilization was fear of or experience
with an abnormal or complicated delivery (Chi et al., 2015). There was a high initial uptake of
implants and a relatively low uptake of IUDs in these crisis affected communities (Rattan et al.,
2016). Reasons for implant preference included positive impressions of implants through word
of mouth, branding of the implant, more familiarity, can be used without a partner’s knowledge,
only requires one trip to the health facility, and is long-lasting. Reasons that IUDs were avoided
included negative associations with IUDs, as some women had complications with this device
when poorly inserted by untrained professionals and fears that this device would cause infertility,
cancer, fetus malformation, and bother the male partner during intercourse (Rattan et al., 2016).
Discussion
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The purpose of this literature review was to assess factors influencing contraceptive use
that were found for refugee women of reproductive age (15-49) in sub-Saharan Africa and for
refugee women displaced from sub-Saharan Africa.
Religious Factors
Overall, the prevalent Islamic beliefs of many of these refugee women was associated
with lower levels of contraceptive use (Kiura, 2014; Gele et al., 2020; Davidson et al., 2017;
Zhang et al., 2020; Agbemenu et al., 2017; UNHCR, 2011; Agbemenu et al., 2020).
Contraceptive use was sometimes viewed as acceptable when being used for birth spacing
(Davidson et al., 2017; Kiura, 2014). Implications of these findings encourage more research into
how health facilities can most effectively provide education and access to contraceptive options,
while considering the beliefs of the local community. There is also little research discussing
factors affecting contraceptive use for other religious groups. The Nigerian Urban Reproductive
Health Initiative examined the relationship between exposure to family planning messages from
religious leaders and contraceptive use and concluded that initiatives focusing on religious
leaders and their messages to their communities could increase contraceptive uptake (Adedini,
2018).
Partners’ Influence
The findings of this literature review conclude that a women’s contraceptive use and
access often depended on the support or consent of their partner (Seyife et al., 2019; Okanlawon
et al., 2010; Bakesiima et al., 2020; Gele et al., 2020). If a woman's partner was involved in
decisions about using contraceptives, these women often had lower uptake (Seyife et al., 2019).
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The family structure in sub-Saharan Africa that reinforces a male as being the head of the
household contributes to the male partner’s more influential decision making power. Husband’s
support for contraceptive use increased a woman's use of these methods (Gele et al., 2020).
Further research is needed to fully understand women’s decision making process for
contraceptive use and partner communication (inclusion in the decision making process, feeling
comfortable discussing contraceptives with your partner, etc).
There were a multitude of socio-cultural factors affecting contraceptive use found in the
literature. The custom in sub-Saharan Africa of having a large family and not wanting to limit the
number of children deterred the utilization of contraceptives (Casey et al., 2015; Royer et al.,
2020). Family planning methods were more widely accepted when being used to space out
pregnancies, rather than limiting the number of children born into a family (Royer et al., 2020;
Agbemenu et al., 2017; Davidson et al., 2017). Some women began to perceive contraceptives in
a more positive manner after personally struggling with the ability to care for all their children or
seeing this in other families (Gele et al., 2020). One factor that increased negative perceptions of
these methods and deterred use was the association of contraceptives with risky sexual behaviors
outside of marriage (Kiura, 2014; Casey et al., 2015). Some refugee community members felt
that modern contraceptives were a Westernized phenomenon that developing countries were
promoting in order to control their fertility (Kiura, 2014; UNHCR, 2011). It is important that
healthcare facilities and providers consider these social and cultural factors when implementing
contraceptive initiatives.
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There are major barriers to accessing contraceptives for these refugee women: lack of a
conveniently located provider facility, little knowledge about where to access, lack of available
health information in one’s native language, feeling uncomfortable discussing contraceptives
with providers, few trained staff members at facilities, lack of availability for long term methods,
and difficulties being able to read or understand family planning messages (Bakesiima et al.,
2020; Seyife et al., 2019; Ganle et al., 2019; Dauda, 2012; Gebrecherkos et al., 2018; Vollmer et
al., 2019; McGinn et al., 2011; Nara et al., 2019; Agbemenu et al., 2017; Kiura, 2014).
Furthermore, lack of availability of permanent and long acting methods, few trained staff
members at health facilities, lack of authorization create supply-side issues for contraceptive
access (Casey et al., 2015; UNHCR, 2011; McGinn et al., 2011). A major obstacle that health
facilities in these refugee communities need to address is finding more effective ways to
communicate services and contraceptives offered at the facility to women in the area. Based on
the barriers found in this review, having information available in multiple languages, providing
information in easier to understand terms, providing information in forms other than written for
those that are illiterate, and improving staff training and contraceptive availability at these
facilities can create more accessibility.
Many women had concerns about the negative effects of contraceptive use on their body
or fertility (Bakesiima et al., 2020; UNHCR, 2011; Kiura, 2014; Gele et al., 2020; Agbemenu et
al., 2020). Some women feared the side effects that can occur when using contraception:
irregular bleeding, general pain, stroke, reduced fertility, and lack of appetite (Davidson et al.,
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2017). Women that had previously utilized birth control noted concerns with weight gain and
heavy bleeding (Chi et al., 2015). Overall, there was a concerning amount of common
misconceptions that contraceptives cause irregular menstruation, bleeding, vitamin deficiencies
and cancer in refugee communities (Kiura, 2014; Gele et al., 2020). Generally, short acting
contraceptive methods were more accepted than long acting contraceptive methods (Okanlawon
et al., 2010). Concerns that condoms reduced sexual pleasure contributed to low condom use
rates for refugee youths (Okanlawon et al., 2010). Contraceptive uptake was more likely with
fear of or experience with an abnormal or complicated delivery (Chi et al., 2015). There was a
high initial uptake of implants and a relatively low uptake of IUDs in these crisis affected
communities due to negative associations with IUDs, as some women had complications with
this device when poorly inserted by untrained professionals and fears that this device would
cause infertility, cancer, fetus malformation, and bother the male partner during intercourse
(Rattan et al., 2016). The general lack of accessible, easy to understand information surrounding
contraceptives likely contributes to this issue of misinformation.
Limitations
A multitude of limitations exist for this literature review. The major limitation of this
review was that many of the studies had small sample sizes of 200 participants or less. Some
sample sizes were as small as 21 participants. Due to the small sample size of some of these
studies, it is difficult to determine if the samples are representative of the sub-Saharan female
refugee population and may not provide generalizable information. Furthermore, not all of the
reviewed studies were looking at specific age ranges, rather than any women in the population of
interest of reproductive age. Multiple studies also cited that language barriers could have affected
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the ability of participants to fully understand complex questions about reproductive health.
Varying study inclusion criteria or sample representation for age, sexual history, average time
residing in the refugee camp/in a certain location, language fluencies, pregnancy status,
education levels, religious affiliations, income levels, careers, recently having children, and
average number of children may have influenced study results.
Another limitation of this literature review is that contraceptive use was defined
differently by certain studies. Some studies only focused on a couple particular methods
(LARCs, condoms, etc.). When comparing the results of the studies, it is important to
acknowledge and consider these varying definitions.
It is also important to note that these studies were only conducted at one or a few refugee
camps/refugee populations at most. This means that these results may not reflect the views and
factors affecting contraceptive use for all refugees in sub-Saharan Africa. Some of the
populations surveyed had also relocated to countries outside of sub-Saharan Africa which may
have impacted their ideas, understanding, and uptake of family planning methods.
Conclusion
This literature review examining that factors are associated with contraceptive use for
refugee women of reproductive age (15-49) in sub-Saharan Africa and for refugee women
displaced from sub-Saharan Africa found multiple factors to be influential for contraceptive use.
Lack of partner support and communication about family planning was related to lower
contraceptive utilization levels. Refugee women also often felt that language and communication
barriers with their healthcare providers. Furthermore, women that had healthcare facilities
providing contraceptives closer to them, were more likely to uptake these contraceptives. Fear of
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the side effects of birth control was a barrier to utilization, even though many of these fears were
misconceptions. Religious influence of congregation leaders could either negatively or positively
influence women’s feelings towards birth control. Many women reported that they did not use
family planning methods, as they felt fertility and conception was in the hands of Allah. In terms
of socio-cultural factors, the cultural norm of having large families prevented contraceptive use.
Another barrier to family planning use was the association of birth control with promiscuity and
risky sexual behaviors. Future research should focus on interventions to address misconceptions
surrounding contraceptive use. The specific barriers to contraceptive access for women living in
refugee camps also needs to be further explored to examine methods for improving these
accessibility issues.
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References
Adedini, S. A., Babalola, S., Ibeawuchi, C., Omotoso, O., Akiode, A., & Odeku, M. (2018). Role
of religious leaders in promoting contraceptive use in Nigeria: Evidence from the
Nigerian Urban Reproductive Health initiative. Global health, science and practice.
Retrieved November 16, 2021, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172128/.
Africa Renewal. (2017). Africa most affected by refugee crisis | africa renewal. United Nations.
Retrieved October 18, 2021, from https://www.un.org/africarenewal/magazine/
december-2016 -march-2017/africa-most-affected-refugee-crisis.
Agbemenu, K., Auerbach, S., Ely, G. E., Aduloji, A. N., & Wang, H. (2020). Family planning
trends among community‐dwelling African refugee women. Public Health Nursing,
37(4), 478–486. https://doi.org/10.1111/phn.12725
Agbemenu, K., Volpe, E. M., & Dyer, E. (2017). Reproductive health decision-making among
US-dwelling Somali Bantu refugee women: A qualitative study. Journal of Clinical
Nursing, 27(17–18), 3355. https://doi.org/10.1111/jocn.14162
20
Bakesiima, R., Cleeve, A., Larsson, E., Tumwine, J. K., Ndeezi, G., Danielsson, K. G., &
Nabirye, R. C. (2020). Modern contraceptive use among female refugee adolescents in
northern Uganda: Prevalence and associated factors. Reproductive Health. Retrieved
November 23, 2021, from https://reproductive-health-journal.biomedcentral.com/
articles/10.1186/s12978-020-00921-y.
Blackstone, S., Nwaozuru, U., & Iwelunmor, J. (2017). Factors influencing contraceptive use in
Sub-Saharan africa: A systematic review. SAGE Journals. Retrieved November 24,
2021, from https://journals.sagepub.com/doi/10.1177/0272684X16685254.
Casey, S., Chynoweth, S., Cornier, N., Gallagher, M., & Wheeler, E. (2015). Progress and gaps
in reproductive health services in three humanitarian settings: mixed-methods case
studies. Conflict and Health, 9(Suppl. 1), S3.
https://doi.org/http://www.conflictandhealth.com/content/9/S1/S3
Chi, P., Bulage, P., Urdal, H., & Sundby, J. (2015). A qualitative study exploring the
determinants of maternal health service uptake in post-conflict Burundi and Northern
Uganda. BMC Pregnancy & Childbirth, 15(1), 1–14.
https://doi.org/10.1186/s12884-015-0449-8
Dauda, D. (2012). Reproductive Health and Repatriation of Refugee Women in Africa: A Case of
Liberian Refugee Women on Buduburam Camp. University of California Journal of
Health. Retrieved November 23, 2021, from
https://escholarship.org/content/qt6rt9d3vr/qt6rt9d3vr.pdf.
21
Davidson, A., Fabiyi, C., Demissie, S., Getachew, H., & Gilliam, M. (2017). Is Larc for
everyone? A qualitative study of sociocultural perceptions of family planning and
contraception among refugees in Ethiopia. Maternal and child health journal. Retrieved
November 23, 2021, from https://pubmed.ncbi.nlm.nih.gov/27206615/.
Ganle, J., Amoako, D., Baatiema, L., & Ibrahim, M. (2019). Risky sexual behaviour and
contraceptive use in contexts of displacement: insights from a cross-sectional survey of
female adolescent refugees in Ghana. International Journal for Equity in Health, 18(1),
1–11. https://doi.org/10.1186/s12939-019-1031-1
Gebrecherkos, K., Gebremariam, B., Gebeyehu, A., Siyum, H., Kahsay, G., & Abay, M. (2018).
Unmet need for modern contraception and associated factors among reproductive age
group women in Eritrean refugee camps, Tigray, north Ethiopia: a cross-sectional study.
BMC Research Notes, 11(1), 1–6. https://doi.org/10.1186/s13104-018-3956-7
Gele, A., Musse, F., Shrestha, M., & Qureshi, S. (2020). Barriers and facilitators to contraceptive
use among Somali immigrant women in Oslo: A qualitative study. PLoS ONE, 15(3),
1–15. https://doi.org/10.1371/journal.pone.0229916
Haider, T., & Sharma, M. (2013). Barriers to family planning and contraception uptake in
Sub-Saharan africa: A systematic review - Taj L. Haider, Manoj Sharma, 2013. SAGE
Journals. Retrieved October 18, 2021, from
https://journals.sagepub.com/doi/pdf/10.2190/IQ.33.4.g.
22
Kiura, A. W. (2014). Constrained Agency on Contraceptive Use among Somali Refugee Women
in the Kakuma Refugee Camp in Kenya. Gender, Technology & Development, 18(1),
147–161.
Kriel, Y., Milford, C., Cordero, J., Suleman, F., Beksinska, M., Steyn, P., & Smit, J. A. (2019).
Male partner influence on family planning and contraceptive use: Perspectives from
community members and healthcare providers in KwaZulu-Natal, South Africa.
Reproductive Health. Retrieved October 18, 2021, from
https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s1
2978-019-0749-y.
Lightbourne, R. (1987). Reproductive preferences and behavior. In J. Cleland, & C. Scott (Eds.),
The World Fertility Survey, (pp. 838–861). Oxford: Oxford University Press.
McGinn, T., Austin, J., Anfinson, K., Amsalu, R., Casey, S. E., Fadulalmula, S. I., Langston, A.,
Lee-Jones, L., Meyers, J., Mubiru, F. K., Schlecht, J., Sharer, M., & Yetter, M. (2011).
Family planning in conflict: results of cross-sectional baseline surveys in three African
countries. Conflict and Health, 5(11), (13 July 2011).
https://doi.org/http://www.conflictandhealth.com/content/5/1/11
Nara, R., Banura, A., & Foster, A. M. (2020). Assessing the availability and accessibility of
emergency contraceptive pills in Uganda: A multi-methods study with Congolese
refugees. Contraception, 101(2), 112–116.
https://doi.org/10.1016/j.contraception.2019.09.008
23
New Security Beat. (2015). What's behind West and Central Africa's youthful demographics?
high desired family size. New Security Beat. Retrieved November 24, 2021, from
https://www.newsecuritybeat.org/2015/05/whats-west-central-
africas-youthful-demographics-high-desired-family-size/.
Ochako, R., Mbondo, M., Aloo, S., Kaimenyi, S., Thompson, R., Temmerman, M., & Kays, M.
(2015). Barriers to modern contraceptive methods uptake among young women in
Kenya: A qualitative study. BMC public health. Retrieved October 19, 2021, from
Okanlawon, K., Reeves, M., & Agbaje, O. (2010). Contraceptive Use: Knowledge, Perceptions
and Attitudes of Refugee Youths in Oru Refugee Camp, Nigeria. African Journal of
Reproductive Health / La Revue Africaine de La Santé Reproductive, 14(4), 16–25.
Rattan, J., Noznesky, E., Curry, D. W., Galavotti, C., Hwang, S., & Rodriguez, M. (2016). Rapid
Contraceptive Uptake and Changing Method Mix With High Use of Long-Acting
Reversible Contraceptives in Crisis-Affected Populations in Chad and the Democratic
Republic of the Congo. Global Health, Science and Practice, 4 Suppl 2, S5–S20.
https://doi.org/10.9745/GHSP-D-15-00315
Royer, P., Olson, L., Jackson, B., Weber, L., Gawron, L., Sanders, J., & Turok, D. (2020). “In
Africa, there was no family planning. every year you just give birth”: family planning
knowledge, attitudes, and practices among Somali and Congolese refugee women after
resettlement to the United States. Qualitative Health Research, 30(3), 391–408.
https://doi.org/https://journals.sagepub.com/doi/full/10.1177/1049732319861381
24
Sato, R., Elewonibi, B., Msuya, S., Manongi, R., Canning, D., & Shah, I. (2020). Why do
women discontinue contraception and what are the post-discontinuation outcomes?
evidence from the Arusha Region, Tanzania. Taylor & Francis. Retrieved November 16,
2021, from https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1723321.
Seyife , A., Fisseha, G., Yebyo, H., Gidey, G., & Gerensea, H. (2019). Utilization of modern
contraceptives and predictors among women in Shimelba Refugee Camp, Northern
Ethiopia. PloS one. Retrieved November 23, 2021, from
https://pubmed.ncbi.nlm.nih.gov/30840634/.
Tsui, A. O., Brown, W., & Li, Q. (2017). Contraceptive practice in Sub-Saharan africa.
Population and development review. Retrieved October 18, 2021, from
UNCHR. (2011). Baseline Study: Documenting Knowledge, Attitudes and Behaviours of Somali
Refugees and the Status of Family Planning Services in UNHCR’s Operation in Nairobi,
Kenya . The UN Refugee Agency. Retrieved November 23, 2021, from
https://www.unhcr.org/4e8c0cbe9.pdf.
UNHCR. (2019). Family Planning Services in refugee settings - UNHCR.
Retrieved October 19, 2021, from https://www.unhcr.org/5e53af2c4.pdf.
UNHCR. (2014). UNHCR Global Trends 2014. UNHCR. Retrieved November 24, 2021, from
https://www.unhcr.org/556725e69.html.
United Nations, Population Division (2019). World Population prospects: The 2019 revision.
New York: United Nations.
25
Vollmer, N., Petras, J., Daverton, B., & Valadez, J. (2019). An assessment of Health Service
coverage in refugee and host communities in Northern Uganda. Elrha. Retrieved
November 23, 2021, from https://www.elrha.org/researchdatabase/an-assessment
-of-health-service-coverage-in-refugee-and-host-communities-in-northern-uganda/.
Westoff, C. (2010). Desired number of children: 2000–2008, DHS Comparative Reports No. In
25, Calverton. MD: ICF Macro.
World Bank. (2020). Refugee population by country or territory of asylum - sub-saharan africa.
World Bank Data. Retrieved October 18, 2021, from
https://data.worldbank.org/indicator/SM.POP.REFG?locations=ZG.
Yeatman, S. E., & Trinitapoli, J. (2008). Beyond denomination: The relationship
between religion and Family Planning in rural Malawi. Demographic research.
Retrieved October 18, 2021, from https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC2867343/.
Zhang, Y., McCoy, E. E., Scego, R., Phillips, W., & Godfrey, E. (2020). A Qualitative
Exploration of Somali Refugee Women’s Experiences with Family Planning in the U.S.
Journal of Immigrant and Minority Health, 22(1),
66.https://doi.org/10.1007/s10903-019-00887-5
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Running Head: CONTRACEPTIVE USE FOR REFUGEE WOMEN SUB-SAHARAN

EXAMINING THE FACTORS ASSOCIATED WITH CONTRACEPTIVE USE FOR

SUB-SAHARAN REFUGEE WOMEN: A REVIEW OF THE LITERATURE

Search Strategy & Data…………………………………………………………………..5

Inclusion Criteria & Selection of Studies……..………………………………..…………………6

Study Samling & Design……………………...…………………….…………………….8

Contraceptive Perception Factors………………………………………...……………12

Africa refugee women of reproductive age (15-49) in sub-Saharan Africa?

displacement is defined as displacement “as a result of persecution, conflict, generalized

their effects on contraceptive use will be examined throughout this review.

be addressed, as well as contraception utilization.

(New Security Beat, 2015).

A study conducted in Malawi found a variety of religious influences on family planning,

but no differences in contraceptive use between denominations. The majority of religious

congregations (Yeatman, S. E., & Trinitapoli, 2008).

relationships, limited understanding about possible side effects (misconceptions on lessening

contraceptive use uptake (Kriel et al., 2019).

communication with patients about contraceptives due to “perceived sociocultural resistance”

sometimes associated with contraceptives in sub-Saharan refugee settings. Furthermore, poor

contraceptive methods (UNHCR, 2019).

Contraceptive Perception Factors

(Blackstone et al., 2017). This is often formed by misinformation or misconceptions, such as

certain methods, specifically injectables, causing infertility (Ochako et al., 2015).

Search Strategy & Data Resources

A literature review was conducted to examine factors and perceptions affecting

reproductive age (15-49) in sub-Saharan Africa?

Inclusion Criteria & Selection of Studies

● Published between 2010-2021

● Published in academic journals

total of twenty articles were selected for this review.

Search Terms and Results that Determined Selected Studies

Table 1: Search terminology and results

Database Terms used Filters Number of Articles

Search #1 UGA Library contraceptive Scholarly (Peer 199 #1, #2,

website, factors AND reviewed) #3, #4,

multi-search refugees Journals, #5, #6,

tool Format: Academic #7, #8,

Journals, Dates: #9, #10,

Search #2 UGA Library reproductive Scholarly (Peer 89 #11, #14,

website, health AND reviewed) #20

multi-search refugee AND Journals,

tool Africa Format: Academic

Search #3 UGA Library contraceptive Scholarly (Peer 354 #15, #16

website, use AND reviewed)

multi-search refugee Journals,

tool Format: Academic

Search #4 UGA Library reproductive Scholarly (Peer 101 #17

website, health AND reviewed)

multi-search humanitarian Journals,

tool AND Africa Format: Academic

Search #5 Google Scholar contraceptive Scholarly (Peer 20,400 #10, #13,

AND refugee reviewed) #18, #19

AND Africa Journals,

Study Sampling & Design

secondary data from research that was done previously.

longitudinal studies need to be conducted.

planning (Davidson et al., 2017; Kiura, 2014).

accompanied by their husbands or having an authorization letter to be able to have access to

family planning services (Gele, et al., 2020).

contraceptive methods were a Westernized phenomenon being perpetuated by developed

countries in order to control their fertility (Kiura, 2014; UNHCR, 2011).

less accessible (Nara et al., 2019).

providers/facilities. Women sometimes felt uncomfortable having discussions with their