Contraceptive use by Palestine refugee mothers of young children attending UNRWA clinics: a cross-sectional follow-up study

Hababeh, Majed; Zeidan, Wafaa; El-Kader, Mariam Abdel; Thaher, Anwar Al; Kassim, Nimer; Habash, Elias; Arab, Hasan; Khader, Ali; Seita, Akihiro

doi:10.1016/s0140-6736(18)30392-1

Cited by 6 publications

(5 citation statements)

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“…Most information on contraception was received informally in the community, which might be one important factor for the limited choice that women made regarding contraception with only three main methods used. Surprisingly low was the use of long-acting reversible contraception (LARC) in this study with only the IUD being used from this category, which was similar to findings by Hababeh et al, who surveyed Palestinian refugee mothers attending UNRWA clinics [26]. Most women receive contraception in the UNRWA or government clinics, which do only offer the Medroxyprogesterone injection and the IUD as LARC.…”

Section: Discussionsupporting

confidence: 86%

Choices and services related to contraception in the Gaza strip, Palestine: perceptions of service users and providers

Böttcher

Abu-El-Noor

2019

BMC Women's Health

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BackgroundReliable contraception enables women and men to plan their family sizes and avoid unintended pregnancies, which can cause distress and anxiety, but also increase maternal mortality. This study explored potential barriers to contraceptive use for women in the Gaza Strip, Palestine from user and provider perspectives.MethodsA convenient sample was used to recruit women, who were current contraception users, from three healthcare clinics that provide family planning care, two governmental and one non-governmental. A 16-item questionnaire was completed by 204 women, including socio-demographic data, contraceptive use and eight questions exploring user experience. Additionally, 51 women attended focus groups for a deeper insight into their contraceptive use experience and potential barriers. Furthermore, 14 healthcare providers were interviewed about their experience with service provision. Quantitative data are presented as means and frequencies and qualitative data were analysed item by item and are presented in themes jointly with the quantitative data.ResultsWomen reported usage of only three main modern methods of contraception with 35.2% using intrauterine devices, 25.8% combined oral contraception and 16.4% condoms, while only 3.1% used the hormonal implant. Expectations from family planning services were low with most women attending the clinic having already decided their contraceptive method with decisions being made by husbands (41.2%) or women jointly with their partner (33.3%), only 13.7% took advice from service providers. Healthcare providers experienced high prevalence of beliefs that modern contraceptives cause infertility and cancer. Main barriers to effective family planning services were misconceptions of potential harm, poor availability and limited choice of contraceptive methods.ConclusionWomen’s contraceptive choices in Gaza are limited by prevalent misconceptions and fears as well as recurring shortages, negatively impacting fertility control. Men are a major factor in choosing a contraceptive method, however, they have limited access to information and therefore, potentially more misconceptions. Therefore, male community members need to be included in the delivery of information on contraceptives to increase women’s choice. Furthermore, greater access to long-acting reversible contraceptives, such as the hormonal implant, and improved availability might be key factors in improving contraceptive uptake in Gaza and, thus, reducing unintended pregnancies.

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Section: Discussionsupporting

confidence: 86%

Choices and services related to contraception in the Gaza strip, Palestine: perceptions of service users and providers

Böttcher

Abu-El-Noor

2019

BMC Women's Health

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“…The extremely poor standard of documentation shown in this study has proven another obstacle in providing safe maternity care. Unfortunately, this has been shown to be a widespread problem in the Gaza-Strip [ 22 , 23 ]. Meticulous, contemporaneous and accurate documentation is the backbone of evaluation and quality improvement in any healthcare system [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Maternal mortality in the Gaza strip: a look at causes and solutions

Böttcher

Abu-El-Noor

Aldabbour

et al. 2018

BMC Pregnancy Childbirth

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BackgroundMaternal mortality is an important health indicator for the overall health of a population. This study assessed the causes and contributing factors to maternal mortality that occurred in the Gaza-Strip between July 2014 and June 2015.MethodsThis is a retrospective study that used both quantitative and qualitative data. The data were collected from available medical records, investigation reports, death certificates, and field interviews with healthcare professionals as well as families.ResultsA total of 18 maternal mortalities occurred in Gaza between 1st July 2014 and June 30th 2015. Age at time of death ranged from 18 to 44 years, with 44.4% occurring before the age of 35 years. About 22.2% were primiparous, while 55.6% were grand multiparous women. The most common causes of death were sepsis, postpartum haemorrhage, and pulmonary embolism.The most striking deficiency was very poor medical documentation which was observed in 17 cases (94%). In addition, poor communication between doctors and women and their families or among healthcare teams was noticed in nine cases (50%). These were repeatedly described by families during interviews. Further aspects surfacing in many interviews were distrust by families towards clinicians and poor understanding of health conditions by women. Other factors included socioeconomic conditions, poor antenatal attendance and the impact of the 2014 war.Low morale among medical staff was expressed by most interviewed clinicians, as well as the fear of being blamed by families and management in case of adverse events. Substandard care and lack of appropriate supervision were also found in some cases.ConclusionsThis study revealed deficiencies in maternity care, some of which were linked to the socioeconomic situation and the 2014 war. Others show poor implementation of clinical guidelines and lack of professional skills in communication and teamwork. Specialised training should be offered for clinicians in order to improve these aspects. However, the most striking deficiency was the extremely poor documentation, reflecting a lack of awareness among clinicians regarding its importance. Local policymakers should focus on systematic application of quality improvement strategies in order to achieve greater patient safety and further reductions in the maternal mortality rate.

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“…Their method mix was comparable to that of refugees in camps in several countries (Rwanda, Cox's Bazar, Bangladesh; Ali Addeh, Djibouti; Amman, Jordan; Eastleigh, Kenya; Kuala Lumpur, Malaysia; and Nakivale, Uganda) whose dominant methods were short-term methods like pills and injectables (21,23), and to Somali refugees in Kampala (8). However, the method mix among Somali refugees in our sample differed from that of Palestinian refugees, whose dominant methods were intrauterine devices (24). This may be related to preferences for specific contraceptive methods among support organizations and refugee women, and to cultural factors.…”

Section: Discussionmentioning

confidence: 65%

Modern contraceptive prevalence and its predictors among non-refugee and refugee Somali women in Nairobi city, Kenya; a comparative view

Gitonga,

Gage

2024

Front. Glob. Womens Health

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Introduction and methodsThis study sought to determine the prevalence and predictors of modern contraceptive use among non-refugee and refugee Somali women in Nairobi City, Kenya. The analysis was based on 976 currently married Somali women aged 15–39 years (non-refugees; 523, refugees; 415) who were interviewed in a 2021 household survey conducted in Kamukunji, Embakasi, and Ruaraka sub-counties of Nairobi City. The analysis was stratified by refugee status and multivariable logistic regression were run to determine predictors of modern contraceptive use in each group.ResultsThe prevalence of modern contraceptives was 34% for the total sample and 43% and 24% for non-refugees and refugees, respectively. The main methods of contraception among non-refugees were injectables, implants, and daily pills, while refugees mainly used male condoms, implants, and injectables. Stratified multivariable analysis showed that residence in formal vs. informal settlements was associated with significantly higher odds of modern contraceptive use among non-refugees but significantly lower odds among refugees, after controlling for other factors. Interaction terms confirmed that the strength of the associations of these variables with the odds of modern contraceptive use varied significantly by refugee status.ConclusionUse of modern methods of contraception was lower among non-refugee and refugee Somali women compared to the national average and refugee status moderated the association of some predictor variables with the odds of modern contraceptive use. To increase use of modern contraceptives in urban areas, it is recommended that the Ministry of Health, refugee agencies, and county governments engage with the Somali community and implement appropriate interventions to empower refugee women economically and promote their access to and use of voluntary contraception services as soon as they settle in urban areas.

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Contraceptive use by Palestine refugee mothers of young children attending UNRWA clinics: a cross-sectional follow-up study

Cited by 6 publications

References 0 publications

Choices and services related to contraception in the Gaza strip, Palestine: perceptions of service users and providers

Choices and services related to contraception in the Gaza strip, Palestine: perceptions of service users and providers

Maternal mortality in the Gaza strip: a look at causes and solutions

Modern contraceptive prevalence and its predictors among non-refugee and refugee Somali women in Nairobi city, Kenya; a comparative view

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