Family planning needs, knowledge and conceptualization among resettled African refugee women
Abortion, Contraception
Awarded 2014
Complex Family Planning Fellowship Research
Pamela Royer, MD
University of Utah

Background: Every year tens of thousands of refugees arrive in the United States. In contrast to other immigrant populations, refugees have often fled war, violence and/or natural disaster. Many refugee women from Somalia and the Democratic Republic of the Congo (DRC) are designated as ‘women-at-risk’ by the United Nations High Commission on Refugees (UNHCR) meaning they have ‘protection problems particular to their gender.’ These women are often victims of sexual and domestic violence, have witnessed the death of loved ones and given birth to children conceived through rape. The transition period after resettlement may be associated with significant changes in reproductive health needs and perceptions. The majority of published research regarding post-resettlement refugee women’s reproductive health has identified divergent beliefs about health care systems between refugee women and host country populations, decreased utilization preventative care including pap smears and mammograms, and increased rates of poor obstetric outcomes. There is a dearth of published information regarding family planning conceptualization and needs after resettlement.
Purpose of the Study: The goal of this project was to obtain a baseline understanding of African refugee women’s needs and attitudes surrounding reproductive health and family planning after resettlement.
Description of Methodology: This project was an embedded mixed methods study utilizing qualitative focus group and quantitative telephone survey methodology. Native language focus groups were held with Congolese and Somali women using guides developed to explore the knowledge, attitudes and practice of resettled refugee women regarding reproductive health concerns, access and barriers to reproductive health care, family planning conceptualization, modern family planning method acceptability, and views on unintended pregnancy and abortion. Preliminary results from the focus group data informed development of a survey including in depth questions regarding family planning needs, knowledge and conceptualizations. This survey was administered via telephone, in native languages, to resettled African refugee women.
Qualitative Findings: Six focus groups were conducted with resettled Somali (n=41) and Congolese (n=25) refugee women between May and August of 2014. Major reproductive health themes identified, and analogous across groups, included: (1) multidimensional concepts regarding health with an emphasis on the ongoing effects of pre-displacement trauma on current health (2) limited health understanding including poor knowledge regarding female anatomy and physiology and (3) barriers to healthcare access including confidentiality concerns, poorly regarded interpreter services and negative interactions with post-resettlement healthcare providers and systems. Participants demonstrated limited knowledge of modern family planning methods and a strong desire for education regarding contraception.
Quantitative Findings: One hundred forty-eight resettled African refugee women completed the telephone survey between September 2014 and March 2015. Knowledge of a broad method mix was demonstrated by both Somali and Congolese refugee women. Congolese women were more likely to be using a modern method than Somali women however modern contraceptive use was low among both groups. Specific method acceptability varied between groups.
Summary statement of relevance: The vulnerabilities that pre-dispose resettled refugee women for the UNHCR women-at-risk category are pervasive, persistent and do not dissipate after resettlement. Development of an understanding of the family planning conceptualizations of these at-risk women is paramount to helping this population of women thrive and improve individual, family and community health. The knowledge gleaned from this research provides a foundation for informing clinical care, devising policy initiatives and defining prospective research efforts among a group of marginalized women with great need.