A qualitative study exploring barriers to adequate uptake of antenatal care in pre-conflict Syria: low cost interventions are needed to address disparities in antenatal care.

Syria has made progress in reducing maternal mortality and morbidity before the conflict in 2011. Despite the improvement in antenatal care (ANC) coverage and patterns of use, analyses of national surveys demonstrated wide regional variations in uptake, timing and number of visits even after controlling for women's socio-demographic characteristics. This study compares two governorates: Latakia, where uptake of ANC was high and Aleppo, where uptake of ANC was low to highlight the barriers to women's adequate uptake of ANC that existed in Syria pre-conflict. This qualitative study carried out 30 semi-structured interviews with (18-45-year-old) pregnant women from Aleppo and Latakia (recruited purposively from different types of health facilities in rural and urban areas), and 15 observation sessions at health facilities. Transcripts and fieldnotes were analyzed using the Framework Method with attention to the dimensions of availability, accessibility and acceptability of services. Inadequate uptake of ANC in Aleppo included not attending ANC, seeking care with providers who are not trained to provide ANC or discontinuing care. Three themes explained the regional disparities in the uptake of ANC in Aleppo and Latakia: women's assessment of their health status and reasoning of causes of ill health in pregnancy; women's evaluation of the risks of seeking ANC; and women's appraisal of the value of different types of service providers. Poor experiences at public health facilities were reported by women in Aleppo but not by women in Latakia. Evaluations of ANC services were connected with the availability, accessibility (geographical and financial) and acceptability of ANC services, however, women's views were shaped by the knowledge and prevailing opinions in their families and community. Findings are utilized to discuss low-cost interventions addressing the disparities in ANC uptake. Interventions should aim to enable vulnerable women to make informed decisions focusing on regions of low uptake. Women's groups that foster education and empowerment, which have been effective in other low resource settings, could be of value in Syria. Increased use of mobile phones and social media platforms suggests mobile health technologies (mHealth) may present efficient platforms to deliver these interventions

Results from the Basmeh & Zeitooneh (B&Z) intervention to empower adolescent girls and young women at risk of child marriage and poor reproductive health among the Syrian refugee population in Lebanon

This report presents results from the final evaluation of a social, health, and economic asset-building program implemented by the Lebanon-based non-governmental organization (NGO) Basmeh & Zeitooneh (B&Z) and aimed at reducing the social isolation of vulnerable adolescent girls and young women (AGYW) aged 10–21 years old living in the Shatila and Burj al Barajneh refugee camps in South Beirut. The program sought to help girls gain the skills and knowledge they need to avoid child marriage and adolescent pregnancy and to make a healthy transition to adulthood despite the numerous challenges they face. The program focused on two sub-populations of girls at heightened risk of poor health and social outcomes: 10–15- year-old girls who are out of school and 13–21 year-old girls who are married. The report presents findings from the most recent iteration of this program, which took place in two phases—Round 2 between May and September 2022 and Round 3 between November 2022 and March 2023—and built upon a previous round of the program—Round 1—which was also conducted in partnership with Population Council (between May and September 2021)

Syrian refugee women’s access to family planning services and modern contraception during overlapping crises in Bekaa, Lebanon

Abstract Background Political, financial, and pandemic crises in Lebanon have affected both provision of reproductive health services including family planning and modern contraception methods as well as women’s interest and ability to seek those services. This study aims to explore the impact of the compounding crises on the provision and use of family planning services including modern contraception methods for Syrian refugees in Lebanon focusing on the perspectives of Syrian refugee women. Methods We carried out 12 Focus Group Discussions (FGDs) with 119 Syrian refugee women recruited from two cities in West Bekaa, Lebanon from inside and outside the informal tented settlements. We used Skype video calls to moderate the FGDs due to the limited mobility at the time of the study because of Covid-19. We used thematic analyses to analyse the data. Results The crises seemed to exacerbate supply side barriers, which influenced provision of family planning services and women’s demand for them. These included Covid-19 regulations and maltreatment by staff at public health facilities, disruption of outreach reproductive health services that provide family planning and modern contraception, and reduced supply of modern contraception methods. On the demand side, women reported financial limitations in accessing and paying for services, concern over being infected with Covid-19, and concerns about insecurity. Conclusions We suggest possible interventions to address these challenges and better reach these populations. These include using mobile health technology (mHealth) that may provide contraceptive counselling and/or can inform refugee women about where they may receive family planning and modern contraception. These services may also support Syrian refugees to access care they are entitled to receive and may also address disruptions in service provision due to overlapping crises, including availability and rising costs of contraceptives. These can be coupled with mobile outreach reproductive health services that provide family planning. We also suggest considering the provision of Long Acting Reversible Contraception (LARC) for Syrian refugee women, which would reduce a barrier of needing to revisit health facilities to obtain an additional supply of contraception pills

Crisis upon crisis: A qualitative study exploring the joint effect of the political, economic, and pandemic challenges in Lebanon on Syrian refugee women\u27s fertility preferences and behaviour

Background: Starting in October 2019, Lebanon experienced overlapping crises that caused a significant deterioration of the living conditions for Syrian refugees and the host community. Previous studies have shown that difficult living conditions and refugee status alone do not impact the fertility preferences of Syrian refugees. This study seeks to explore the effect of the overlapping crises on the fertility preferences and behaviour of Syrian refugees in Lebanon. Methods: In this qualitative study, we carried out focus group discussions (FGDs) with married female Syrian refugees recruited purposively from two cities in West Bekaa (Bar Elias and Saad Nayel) and from inside and outside the Informal Tented Settlements (ITS). Transcripts were analysed using thematic analysis. Results: The overlapping crises (political, economic, and Covid-19) in Lebanon influence Syrian refugee women’s reported desire for fewer children. Two themes emerged that explained the change in Syrian refugees’ fertility preferences towards limiting their number of children or delaying having children, and potentially a change in their fertility practices: the sudden deterioration in their living conditions triggered by the effect of inflation on their daily needs, and decreased support and changes in the job market that led to more women working to support their families. Consequently, refugees expressed a preference towards limiting their number of children due to concern about the consequences of the crisis on their children’s physical and mental well-being. This was combined with decreased pressure on women from men and in-laws to have (additional) children and concern over the effect of Covid-19 on pregnant women. Conclusions: The sudden deterioration in living conditions due to the overlapping crises may have influenced Syrian refugees’ preferences towards limiting their number of children or delaying having children until the situation improves. The potential shift in power dynamics in households caused by more women working outside the home also may have increased women’s autonomy in making decisions regarding family size and use of modern contraception. These findings have implications for developing programs that focus on female livelihoods and engagement in work outside the home to influence family size and other reproductive health outcomes and gender equity indicators

Focus group discussions on Syrian refugees\u27 access to reproductive health services in Lebanon

Data collection included twelve Focus Group Discussions (FGDs). In each city (Bar Elias and Saad Nayel), we carried out: a) Two FGDs with 15–19-year-old married girls (one FGD with women living inside Informal Tented Settlements [ITS] and one FGD outside ITS). We included young girls to understand their demand for and access to RHS and modern contraception methods given the high risks of adolescent pregnancy. b) Two FGDs with 20–35-year-old married women inside and outside the ITS. C) Two FGDs with women who were above 35-year-old (inside and outside ITS) and who were often mothers or mothers-in-law of women or girls married before age 18. We wanted to include this group of women given their important role in the decision-making process regarding use of RHS and FP. FGDs guide covered the following: the current hardships experienced by refugees that emerged since the political, financial, and pandemic crises; the influence of the crises on refugees’ perception of ideal number of children and their demand for modern contraception; current access to RHS and use of modern contraception and women’s suggestions of strategies to improve their access to RHS given the current crises. Both guides were pretested in June 2020 before data collection

A qualitative study exploring child marriage practices among Syrian conflict-affected populations in Lebanon

Abstract Background Recent reports have suggested that child marriage among Syrians may be increasing as a result of displacement and conflict. This study sought to gather qualitative data about the factors that promote child marriage practices among Syrian refugees in Al Marj area in the Bekaa valley, Lebanon, where the majority of Syrian refugees have settled in Lebanon. The second aim of this study was to generate recommendations on how to mitigate the drivers and consequences of child marriage practices based on the findings. Methods Eight focus group discussions were conducted separately with married and unmarried young women and mothers and fathers of married and unmarried women. Furthermore, researchers conducted 11 key informant interviews with service providers and stakeholders to understand how conflict and displacement influenced marriage practices of Syrian refugees in Al Marj community. Results Although child marriage was a common practice in pre-conflict Syria, new factors seem to contribute to a higher risk of child marriage among Syrian refugees in Lebanon. Respondents cited conflict- and displacement-related safety issues and feeling of insecurity, the worsening of economic conditions, and disrupted education for adolescent women as driving factors. Service providers, young women, and parents also reported changes in some marriage practices, including a shorter engagement period, lower bride price, change in cousin marriage practices, and a reduced age at marriage. Conclusions Recommendations for interventions to mitigate the drivers of child marriage and its negative consequences should be built on a clear understanding of the local refugee context and the drivers of child marriage in refugee settings. Interventions should involve multiple stakeholders, they should be adjusted to target each specific context, age group and marital status. For these interventions to be effective, they should be addressed concurrently, and they should be delivered in a culturally sensitive and practical manner

Webinar—Adaptations in Crisis: Stress Testing our Intentional Design Model for Girls\u27 Programs

This webinar briefly reviews the Population Council\u27s Community of Practice\u27s theory of change of how emergencies are mediated through girls, in line with conclusions of the initial Girls in Emergencies Consultation (2013) and the continuing efforts of the Girls in Emergencies (GiE) Collaborative. The challenge is how to act safely and lay the foundations for girls and young women to not only be protected but also be validated in their vital role in health promotion as this pandemic unfolds. Reports from Guatemala, Lebanon, Ethiopia, Bangladesh, and Mozambique highlight how to positively engage girls, their families, and communities in response to the Covid-19 pandemic. Includes short updates from Community of Practice partners in Haiti, Tanzania, Nigeria, and the Indigenous Adolescent Girls Empowerment Network (IMAGEN)

Webinar—Mental Health is Foundational: An Adolescent Girls Community of Practice Learning Exchange

Hosted by the Adolescent Girls Community of Practice (CoP), this webinar features members of the CoP, who discuss the mental health challenges the girls they work with are facing and share their experiences and insights on strategies to support girls\u27 mental health

Conducting Research in Humanitarian Settings: A Learning Session

On August 4, 2021, the Humanitarian Task Force (HTF) at the Population Council hosted a learning seminar with partners to discuss our experiences with gathering and generating relevant and high-quality data and evidence to produce effective solutions for people affected by complex emergencies, natural disasters, and post-conflict crises. Click here to learn more about the HT