Perspectives of displaced Syrian women and service providers on fertility behaviour and available services in West Bekaa, Lebanon

Abstract

Prior to the conflict, Syria had relatively high fertility rates. In 2010, it had the sixth highest total fertility rate in the Arab World, but it witnessed a fertility decline before the conflict in 2011. Displacement during conflict influences fertility behaviour, and meeting the contraceptive needs of displaced populations is complex. This study explored the perspectives of women and service providers about fertility behaviour of and service provision to Syrian refugee women in Bekaa, Lebanon. We used qualitative methodology to conduct 12 focus group discussions with Syrian refugee women grouped in different age categories and 13 in-depth interviews with care providers from the same region. Our findings indicate that the displacement of Syrians to Lebanon had implications on the fertility behaviour of the participants. Women brought their beliefs about preferred family size and norms about decision-making into an environment where they were exposed to both aid and hardship. The unaffordability of contraceptives in the Lebanese privatised health system compared to their free provision in Syria limited access to family planning services. Efforts are needed to maintain health resources and monitor health needs of the refugee population in order to improve access and use of services.

A Qualitative Analysis of Knowledge, Attitudes, and Perceptions of Family Planning Among Syrian Refugees in Lebanon

“…These safety concerns have, in part, led to an increased rate of child marriage and decreased age at which many Syrian girls are married in Lebanon [7]. Reports indicate that some Syrian families feel threatened by the more 'liberal' Lebanese values, economic insecurity, lack of access to education for girls, and fear of physical harm [5,8,9], perhaps contributing to decisions to marry their daughters earlier. In 2017, approximately 35% of Syrian refugee girls in Lebanon were reportedly married before the age of 18 compared to 13% of girls marrying in Syria before the age of 18 in 2006 [10].…”

“…Fertility patterns are a complex issue driven by a range of interconnected factors [8,21]. Earlier qualitative research with Syrian women in Lebanon identified a number of reasons for wanting children, including believing that it was god's will, believing that having more children would increase access to aid, wanting to replace children lost in the conflict, concern about the cost of contraception, and desperation to have a son [8].…”

“…Fertility patterns are a complex issue driven by a range of interconnected factors [8,21]. Earlier qualitative research with Syrian women in Lebanon identified a number of reasons for wanting children, including believing that it was god's will, believing that having more children would increase access to aid, wanting to replace children lost in the conflict, concern about the cost of contraception, and desperation to have a son [8]. Additionally, pervasive societal expectations about having a child immediately following marriage, and feeling forced to conceive out of fear that husbands would abandon them if they did not prove their fertility, may influence girls' desire for pregnancy [22,23].…”

“…Existing studies also show that pre-conflict awareness/ use of contraception, prevailing beliefs from the host country, and access to SRH services all influence women's perceptions of contraception [8]. In pre-conflict Syria, most primary care and SRH services were free [24] and estimates of contraception use ranged between 54% and 60% with approximately 84% of FP needs being met [25][26][27].…”

“…Despite increased efforts to provide information on FP and SRH, few girls are able to attend programs because they are often not allowed to leave home without an accompanying male adult [27,28]. Even when Syrian girls and women do access services, they often perceive that they are judged and mistreated [29] as well as viewed negatively by Lebanese health care providers [8]. Misinformation about harmful side effects as well as banning of contraception by husbands and family members were identified as barriers to FP uptake in pre-conflict Syria and continue to be cited by some refugees after displacement [25][26][27].…”