Exploring disparities and drivers of contraceptive use among Syrian refugee youth: evidence from a mixed-methods study in Jordan.

Background: Access to sexual and reproductive health services is an explicit element of the Sustainable Development Goals, and is critical for achieving family planning goals and broader well-being of young people. Youth (15-24 years) face many barriers to accessible, quality services, and refugees often experience additional barriers due to physical, economic, legal and/or social exclusion. This study explored these barriers in the context of Jordan, a country that has one of the highest proportions of refugees globally.

Methods: This concurrent mixed-methods study utilizes the 2022-2023 Gender and Adolescence: Global Evidence survey data collected from 313 married female youth living in Jordan to describe utilization of contraceptives among Jordanians and Syrian refugees, exploring the role of residence (formal refugee camp, host community or informal tented settlement) and factors associated with contraceptive use among Syrian refugees. A multivariable linear probability model and qualitative data from in-depth individual interviews and focus group discussions were used to explore underlying factors driving differences in contraceptive utilization among Syrian refugee youth.

Results: The survey found that 63.4% of Jordanian youth and 42.8% of Syrian refugee youth were recently using contraception, with notable differences in type of contraceptive method used by both refugee status and residence. Among Syrian refugee youth, living in a host community emerged as a key factor associated with contraceptive use, as it was associated with a 19.6 percentage point increase in the likelihood of using contraception compared to those living in refugee camps. Qualitative themes nuance these findings, suggesting that living in a refugee camp where there is more restricted access to healthcare services, more salient social norms, and limited knowledge about reproductive health present barriers to contraceptive use for Syrian refugee youth.

Conclusions: These results highlight that youth-friendly reproductive health services are having mixed efficacy in Jordan. Understanding barriers to contraception should inform family planning services for marginalized groups like Syrian refugee youth. There is a need for evidence-informed efforts to expand provision of family planning counselling and access to contraceptives for young married couples in Jordan, and especially for those living in formal refugee camps.