Emergency contraception in post-conflict Somalia: assessing awareness and perceptions of need

AbstractBackgroundThe national health system in Somalia has been seriously undermined by almost two decades of civil war and conflict. Somalia's high total fertility rate, high maternal mortality ratio, and low contraceptive prevalence rate coupled with restrictive abortion laws make addressing the lack of family planning services an important priority. In crisis and conflict or post-conflict settings such as Somalia, emergency contraception can be important for pregnancy prevention, yet Somalia remains one of the few countries in the world without a registered progestin-only emergency contraceptive pill. In 2014, we conducted fieldwork in Somalia to explore awareness of and attitudes to emergency contraception.MethodsWe conducted a qualitative, multi-methods study comprised of ten formal, semi-structured interviews with key informants (ie, physicians, non-governmental officials, and government officials) in Mogadishu, structured, in-person interviews with 20 Somali pharmacists in a range of neighbourhoods, and four focus group discussions with 21 married and unmarried Somali women. Most key informants and pharmacists were purposively sampled, with additional participants recruited through snowball sampling. Focus group participants were recruited through our study's partner non-governmental organisations in Mogadishu. Findings from this study will be disseminated to stakeholders in the form of a summarised report and will inform future projects and policies about the potential expansion of emergency contraception in Somalia.FindingsResponses from most participants showed little knowledge of existing family planning methods or emergency contraception. However, once emergency contraception was described, all participants expressed tremendous enthusiasm for expanding access to post-coital contraceptive methods in Somalia. They believed that the provision of emergency contraception would fill a major gap in reproductive health service delivery. All stakeholders involved in the study identified ways that emergency contraception could be incorporated into the health system.InterpretationAlthough importation and use of pharmaceuticals in Somalia is severely unregulated, and measures for formal registration of medications in Somalia do not exist, results from our study highlight mechanisms that could be explored to expand access to emergency contraception in Somalia. This study sheds much needed light on why Somalia continues to be a global exception with respect to a dedicated product and suggests that there are possible avenues for overcoming existing barriers.FundingThis study has received funding from the Society of Family Planning's Research Fund, as well as the Faculty of Graduate and Post-doctoral Studies at the University of Ottawa