Barriers to Contraceptive Access in Disaster Situations: A Systematic Review of Health System Preparedness and Socio-Cultural Challenges
Abstract
Introduction: This study examines barriers to access to contraceptive services in disaster situations in the context of reproductive health system preparedness and socio-cultural challenges. According to the United Nations Population Fund (UNFPA) report in 2022, 51.3% of married women have not used contraceptives, and around 11.3% of family planning needs are unmet. In disaster situations, these problems are further complicated by limited infrastructure, unequal distribution of services, and weak health system preparedness. The inability to meet contraceptive needs can increase the risk of unplanned pregnancies and reproductive health complications, exacerbating the impact of disasters on women and other vulnerable groups. This study aims to fill this research gap by providing a comprehensive review of the factors that hinder access to contraceptive services during disasters and proposing policy-based strategies to improve health system preparedness in emergency response.
Methods: This study is a systematic review that collects several studies according to PRISMA guidelines. Using relevant keywords, studies were obtained from PubMed, Science Direct, and Scopus databases. Studies were collected from June to July 2024.
Results: Key findings suggest that socio-cultural, religious, and economic factors influence barriers to contraceptive access during disasters. Limited knowledge, social stigma, cultural and religious norms, and financial instability contribute to low utilization of contraceptive services. In addition, disruptions due to disasters and the COVID-19 pandemic limit community mobility, hinder access to health facilities and exacerbate service gaps for vulnerable groups, including refugees and migrants.
Conclusion: This study highlights the importance of a human rights-based approach in ensuring the accessibility of contraceptive services in crisis situations. Policy implications include strengthening reproductive health systems in emergency response, reducing stigma through community education, and increasing stakeholder engagement in ensuring equitable distribution of services. The results of this study contribute to the global discourse on reproductive health rights in disaster contexts and provide a basis for innovative strategies to expand access to services in conflict-affected or remote areas.
References
UNFPA. Unmet Need for Family Planning on Married Women. 2022.
Loewen S, Pinchoff J, Ngo TD, Hindin MJ. The impact of natural disasters and epidemics on sexual and reproductive health in low- and middle-income countries: A narrative synthesis. International Journal of Gynecology and Obstetrics. 2022;157(1):11–8.
Simmons RG, Baayd J, Elliott S, Cohen SR, Turok DK. Improving access to highly effective emergency contraception: an assessment of barriers and facilitators to integrating the levonorgestrel IUD as emergency contraception using two applications of the Consolidated Framework for Implementation Research. Implement Sci Commun. 2022;3(1).
Svallfors S. The remarkable stability of fertility desires during the Colombian armed conflict 2000–2016. Popul Space Place [Internet]. 2022;28(1). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85115968940&doi=10.1002%2fpsp.2514&partnerID=40&md5=8e97fe8a82473187b1337cf015afcd2c
Nurtyas M. Pelayanan Kesehatan Ibu Dan Anak Pascabencana ( Stusi Kasus Gempa Dan Tsunami Di Huntara Balaroa , Post Disaster Maternal and Child Health Care ( Case Study of Earthquake and Tsunami in Huntara. Seminar NAsional UNRIYO. 2019;1–5.
Ellington SR, Kourtis AP, Curtis KM, Tepper N, Gorman S, Jamieson DJ, et al. Contraceptive Availability During an Emergency Response in the United States. J Womens Health. 2013 Mar;22(3):189–93.
Åkerman E, Larsson EC, Essén B, Westerling R. A missed opportunity? Lack of knowledge about sexual and reproductive health services among immigrant women in Sweden. Sexual & Reproductive Healthcare. 2019;19:64–70.
Kementerian Kesehatan. Pedoman Pelaksanaan Paket Pelayanan Awal Minimum (PPAM) Kesehatan Reproduksi Pada Krisis Kesehatan. Jakarta; 2021.
Nugroho E, Nisa AA, Alifah RN, Raharjo BB, Utami ANM, Hermawan DY. Implementation of the Minimum Initial Service Package (MISP) as an Effort to Fulfill Reproductive and Sexual Health Services in Disaster Situations: Systematic Review. Media Publikasi Promosi Kesehatan Indonesia (MPPKI) [Internet]. 2025 Jan 14;8(1):42–55. Available from: https://jurnal.unismuhpalu.ac.id/index.php/MPPKI/article/view/6485
Achola R, Atuyambe L, Nabiwemba E, Fredrick M, Orach CG. Factors associated with family planning use among refugee and host populations in Adjumani district, West Nile, Uganda: a comparative study. BMC Public Health. 2024;24(1).
Casey SE, Gallagher MC, Kakesa J, Kalyanpur A, Muselemu JB, Rafanoharana R V, et al. Contraceptive use among adolescent and young women in North and South Kivu, Democratic Republic of the Congo: A cross-sectional population-based survey. PLoS Med. 2020;17(3).
Hammond N, Steels S, King G. Contraceptive and pregnancy concerns in the UK during the first COVID-19 lockdown: A rapid study. Sexual and Reproductive Healthcare. 2022;33.
Márquez-Lameda RD. Predisposing and enabling factors associated with Venezuelan migrant and refugee women’s access to sexual and reproductive health care services and contraceptive usage in Peru. J Migr Health. 2022;5:100107.
Mourtada R, Melnikas AJ. Syrian refugee women’s access to family planning services and modern contraception during overlapping crises in Bekaa, Lebanon. BMC Womens Health. 2023;23(1).
Nara R, Banura A, Foster AM. Assessing the availability and accessibility of emergency contraceptive pills in Uganda: A multi-methods study with Congolese refugees. Contraception. 2020;101(2):112–6.
Rahman A, Giyarsih SR, Santosa SHMB. Desire to Have Children Reviewed from Reproductive Health as the Impact of Natural Disasters in Palu, Indonesia. International Journal of Sustainable Development and Planning. 2023;18(8):2599–604.
Rezaei F, Amiri-Farahani L, Haghani S, Pezaro S, Behmanesh F. The impact of the COVID-19 pandemic on contraceptive methods, abortion, and unintended pregnancy: a cross-sectional study. BMC Womens Health. 2023;23(1).
Rivillas-García JC, Cifuentes-Avellaneda Á, Ariza-Abril JS, Sánchez-Molano M, Rivera-Montero D. Venezuelan migrants and access to contraception in Colombia: A mixed research approach towards understanding patterns of inequality. J Migr Health. 2021;3:100027.
Sigdel A, Bista A, Sapkota H, van Teijlingen E. Barriers in accessing family planning services in Nepal during the COVID-19 pandemic: A qualitative study. PLoS One. 2023;18(5 MAY).
Tran NT, Meyers J, Malilo B, Chabo J, Muselemu JB, Riziki B, et al. Strengthening Health Systems in Humanitarian Settings: Multi-Stakeholder Insights on Contraception and Postabortion Care Programs in the Democratic Republic of Congo and Somalia. Front Glob Womens Health. 2021;2(August):1–11.
Freed B, Hillman S, Shantikumar S, Bick D, Dale J, Gauly J. The impact of disasters on contraception in OECD member countries: a scoping review. European Journal of Contraception and Reproductive Health Care. 2021;26(5):429–38.
Ivanova O, Rai M, Mlahagwa W, Tumuhairwe J, Bakuli A, Nyakato VN, et al. A cross-sectional mixed-methods study of sexual and reproductive health knowledge, experiences and access to services among refugee adolescent girls in the Nakivale refugee settlement, Uganda. Reprod Health. 2019 Dec 19;16(1):35.
Svallfors S, Båge K, Ekström AM, Elimian K, Gayawan E, Litorp H, et al. Armed conflict, insecurity, and attitudes toward women’s and girls’ reproductive autonomy in Nigeria. Soc Sci Med. 2024;348.
Pierce H. Reproductive health care utilization among refugees in Jordan: Provisional support and domestic violence. Women’s Health. 2019;15.
Casey SE, Steven VJ, Deitch J, Dumas EF, Gallagher MC, Martinez S, et al. “You must first save her life”: community perceptions towards induced abortion and post-abortion care in North and South Kivu, Democratic Republic of the Congo. Sex Reprod Health Matters. 2019;27(1):106–17.
Endler M, Al-Haidari T, Benedetto C, Chowdhury S, Christilaw J, El Kak F, et al. How the coronavirus disease 2019 pandemic is impacting sexual and reproductive health and rights and response: Results from a global survey of providers, researchers, and policy-makers. Acta Obstet Gynecol Scand. 2021;100(4):571–8.
Aly J, Choi L, Christy AY. The impact of coronavirus on reproduction: contraceptive access, pregnancy rates, pregnancy delay, and the role of vaccination. F S Rev. 2022;3(3):190–200.
Singh L, Abbas SM, Roberts B, Thompson N, Singh NS. A systematic review of the indirect impacts of COVID-19 on sexual and reproductive health services and outcomes in humanitarian settings. BMJ Glob Health. 2023;8(11).
Roland N, Drouin J, Desplas D, Duranteau L, Cuenot F, Dray-Spira R, et al. Impact of coronavirus disease 2019 on contraception use in France. Therapies. 2023;78(5):593–603.
Horner-Johnson W, Moe EL, Stoner RC, Klein KA, Edelman AB, Eden KB, et al. Contraceptive knowledge and use among women with intellectual, physical, or sensory disabilities: A systematic review. Disabil Health J. 2019;12(2):139–54.
Nara R, Banura A, Foster AM. Exploring Congolese refugees’ experiences with abortion care in Uganda: a multi-methods qualitative study. Sex Reprod Health Matters. 2019;27(1).
Balinska MA, Nesbitt R, Ghantous Z, Ciglenecki I, Staderini N. Reproductive health in humanitarian settings in Lebanon and Iraq: Results from four cross-sectional studies, 2014-2015. Confl Health. 2019;13(1).
Fetters T, Rubayet S, Sultana S, Nahar S, Tofigh S, Jones L, et al. Navigating the crisis landscape: Engaging the ministry of health and United Nations agencies to make abortion care available to Rohingya refugees. Confl Health. 2020;14(1).
Bress J, Kashemwa G, Amisi C, Armas J, McWhorter C, Ruel T, et al. Delivering integrated care after sexual violence in the Democratic Republic of the Congo. BMJ Glob Health. 2019;4(1).
Copyright (c) 2025 Media Publikasi Promosi Kesehatan Indonesia
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with Media Publikasi Promosi Kesehatan Indonesia retain the copyright of their work. The journal applies a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0), which grants the following rights:
-
Copyright Retention: Authors retain the copyright of their work, maintaining full control over their intellectual property without restrictions.
-
Right of First Publication: Authors grant the journal the right of first publication of their work. This ensures that the work is initially published and credited in Media Publikasi Promosi Kesehatan Indonesia.
-
License to Share and Reuse: The work is licensed under CC BY-SA 4.0, allowing others to copy, distribute, remix, and build upon the work for any purpose, even commercially, as long as proper credit is given to the authors, and any new creations are licensed under the same terms.
