Family planning in conflict: results of cross-sectional baseline surveys in three African countries

TLDR

Conflict severely hampers reproductive health access due to insecurity, staff shortages, and supply gaps, and family planning is especially neglected, underscoring the need to include refugee and internally displaced women in national and donor plans. The studies aimed to guide program activities and establish a baseline for measuring future program achievements. Researchers conducted household surveys of married or in‑union women and health facility assessments in six conflict‑affected sites, double‑entered data into CSPro 3.2, and used SAS 9.2 to compute descriptive statistics. Baseline data revealed low modern contraceptive knowledge and use (under 4 % in most sites, up to 16.2 % where services existed), a strong desire for spacing or limiting births among 30–40 % and 12–35 % of women, and that only about one‑third of facilities had adequate staff, equipment, and supplies, indicating a severe mismatch between demand and service availability.

Abstract

Despite the serious consequences of conflict for reproductive health, populations affected by conflict and its aftermath face tremendous barriers to accessing reproductive health services, due to insecurity, inadequate numbers of trained personnel and lack of supplies. Family planning is often particularly neglected.In six conflict-affected areas in Sudan, northern Uganda and the Democratic Republic of Congo, household surveys of married or in-union women of reproductive age were conducted to determine baseline measures of family planning knowledge, attitudes and behaviors regarding contraception. Health facility assessments were carried out to assess baseline measures of family planning services availability. Data were double-entered into CSPro 3.2 and exported to SAS 9.2, which was used to calculate descriptive statistics. The studies' purposes were to guide program activities and to serve as a baseline against which program accomplishments could be measured.Knowledge of modern contraceptive methods was low relative to other sub-Saharan African countries, and use of modern methods was under 4% in four sites; in two sites with prior family planning services it was 12% and 16.2%. From 30% to 40% of women reported they did not want a child within two years, however, and an additional 12% to 35% wanted no additional children, suggesting a clear need for family planning services. The health facilities assessment showed that at most only one-third of the facilities mandated to provide family planning had the necessary staff, equipment and supplies to do so adequately; in some areas, none of the facilities were prepared to offer such services.Family planning services are desired by women living in crisis situations when offered in a manner appropriate to their needs, yet services are rarely adequate to meet these needs. Refugee and internally displaced women must be included in national and donors' plans to improve family planning in Africa.