Socio-cultural challenges of family planning initiatives in conflict and humanitarian refugee settings: A population case study

Provision of family planning services for refugee populations in humanitarian settings has been increasing. Availability of services, however, does not translate into acceptability and access, and understanding socio-cultural aspects is critical to ensure utilization of services. There often exist misconceptions and low levels of knowledge about family planning. Populations may see limiting pregnancies as counterproductive in light of high child mortality or suspicious in the context of ethnic cleansing.  Larger family size has the perceived advantage of additional assistance with family duties in a subsistence structure, security for the community or tribe, and a social service investment for parents as they age. There may be religious and moral objections to contraception. Any service planning must take into account community perceptions and address socio-cultural contextual subtleties. Ongoing community education via local initiatives from within the refugee community, region-wide structural strategies, and efforts to reconcile family planning services with faith are crucial.  Through the len of a case study of IDPs in Sudan, coupled with a review of literature, we aim to provide perspectives on the provision of family planning services among refugee populations to expose common themes in barriers to acceptance and uptake of provided services and suggest strategies to overcome these barriers.