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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]