Unplanned pregnancy and contraceptive use in humanitarian settings: the case of Syrian refugee women in Lebanon

BACKGROUND: Contraception is a vital component of reproductive health, yet refugee women often face multiple barriers to accessing family planning (FP) services. This study aimed to explore contraception experiences, practices, and adherence among Syrian refugee women in Lebanon and to identify key sociodemographic predictors influencing contraceptive use. METHODS: A descriptive, cross-sectional study was conducted between November 2023 and March 2024 among 790 married Syrian refugee women aged 18-50 across four Lebanese governorates. Structured face-to-face interviews were conducted using a validated questionnaire. Descriptive statistics and logistic regression were used to analyze the data. RESULTS: Nearly 45% had experienced an unplanned pregnancy, with 27.4% resulting in spontaneous miscarriage and 11.3% ending in medical or surgical abortion. About 67.1% were using contraception, with withdrawal (33.2%), intrauterine devices (30.4%), and oral contraceptive pills (OCPs) (19.8%) being the most frequently used method. Among OCP users, 40% were unaware of the medication name, though adherence was generally high (mean score = 21.95 ± 3.68 on a 25-point scale). Logistic regression showed that higher parity (adjusted odds ratio [AOR] = 41.03), residing in Lebanon more than ten years (AOR = 1.57), and employment (AOR = 1.49) were significant predictors of contraceptive use (p < 0.001). Primary barriers to non-use included the desire for more children (31.9%) and spousal opposition (20.4%). More than half of the participants (52.8%) reported at least one chronic condition, with migraine with aura, hypertension, and cardiovascular disease being most common. CONCLUSION: The high prevalence of unplanned pregnancy (44.5%) and reliance on traditional methods (33.2%) highlight critical gaps in reproductive healthcare. For women with an unmet need for contraception, cultural, informational, and systemic barriers hinder access to modern methods. Improving education, engaging men in FP initiatives, strengthening healthcare infrastructure, and enhancing access to affordable contraceptive methods are essential for advancing reproductive autonomy and health in this vulnerable population.