Community level perceptions and experiences of reproductive health services among Syrian refugee women in Zaatari Camp, Jordan

Abstract

Background
In humanitarian crises, the reproductive health needs of women do not disappear. Women living in refugee camps, in addition to other complications and hardships, are also prone to other challenges related to their reproductive health life. In Zaatari camp, Jordan, reproductive health care is considered to be one of the most established public service programmes, yet the level of family planning service uptake is relatively low. Few studies have been conducted to gain a deep understanding of the factors influencing women’s decisions in this area. Hence, this thesis aimed to generate an understanding of the community- level perceptions and experiences of reproductive health services among Syrian women aged 18-49 years, a component of which is the decision-making process.
Methods
A qualitative study design was used, and data were collected via in-depth interviews and focus group discussions (FGDs) between February and May 2019. Ten in-depth interviews with health professionals and social worker who have experience in reproductive health in Zaatari camp and five FGDs were conducted. Six Syrian refugee women participated in each FGD in the following age groups (years); 18-24, 25-30, 31-37, 38-44 and 45-49. A thematic analysis approach was used to analyse the findings and synthesise codes into themes. The overarching theory used in this study was Dahlgren and Whitehead’s 'rainbow model’, and two other theories, Lukes’s framework, and ‘negotiated order’ theory, were used to discuss the themes.

Results
It was found that most women were not in a position to make free choices for a multitude of reasons. These include a lack of power and agency among women in the camp to negotiate with family members to decide their own reproductive health life, barriers related to social and community norms that encourage norms, and tradition and culture that expect women to have many children at a young age in order to preserve tradition, maintain the status quo of the tribe and fulfil other social and economic needs. There are also challenges related to the structures of power within the family, particularly the mothers-in law who advocate against the use of such services, and finally interventions that are culturally insensitive and do not correspond to women’s needs and their daily routine life.
Conclusions
The key conclusion this thesis was that for women to be empowered to make free and informed choices about their reproductive health, there is a need to train service providers to design a culturally sensitive intervention that corresponds to women’s needs and complements their daily life routine, and enables women to be empowered to negotiate their needs with their spouses and mothers-in-law. Moreover, facilitating an enabling environment and opportunities for women to help them start negotiating and making their own decisions regarding their reproductive health with community support for her decision is key.
Keywords
Displacement, camp, refugee, reproductive health and family planning

Date of Award	16 Jun 2021
Original language	English
Awarding Institution	University of Bath
Supervisor	David Wainwright (Supervisor)