Factors associated with decision making about family planning use by refugee and host populations in Adjumani district, West Nile, Uganda: A cross-sectional Comparative study

Abstract

Introduction Uganda currently hosts an estimated 1.5 million refugees with the majority, (60.5%, n = 964,960) from South Sudan with low Family Planning (FP) use. Therefore, we investigated factors associated with decision-making about FP use by refugee and host populations in Adjumani district, Uganda. Methods This study used a comparative cross-sectional study using structured questionnaires to collect data. A total of 1,307 respondents were randomly selected using multi-stage cluster sampling. Quantitative data were analyzed using STATA V.14 C. Results The study found that modern FP use was 28.4% among refugees and 28.6% among hosts. Several factors were found associated with FP use including religion, joint decision, and husband approval. Anglicans were more times likely to use FP compared to Catholics, with AOR = 6.21, 95% CI [1.11-34.57] and AOR =5, 95% CI [4.75-13.23] respectively. Respondents who made joint decisions were more likely to use modern FP compared to those who made a personal decision; AOR = 2.69, 95% CI [0.89-138.39] and AOR= 7.05 95% CI [2.8-44.88] among host and refugees respectively. The key barriers to FP use by hosts included harassment of women who did not consult their significant others (AOR = 0.07, 95% CI [0.01-0.79] and separation/divorce (AOR = 0.03, 95% CI [0.00-0.35]. Amongst refugees, key barriers to not using FP included not wanting to use FP” [45.8%] and wanting to become pregnant [6.8%]. Conclusions The study identified low FP use among refugees and hosts. The main factors associated with the decision to use FP included religion, joint decision, and the husband’s approval. The main reasons for not using modern FP included fear of side effects by hosts and not wanting to use FP by refugees. These factors can deter women from deciding to use FP. Therefore, sensitizing both communities about the benefits of FP is crucial.