Limited method choice, contraceptives access and use during Lebanon's political-economic crisis: a mixed-methods, longitudinal study.

backgroundDisruptions in contraceptive access during crises can have negative effects on women's reproductive autonomy. Since 2019, Lebanon has experienced a multifaceted political-economic crisis that has severely impacted the healthcare sector and pharmaceutical imports. The objective of this study was to explore access to, use of, and continuation of contraceptives in Lebanon across the range of the contraceptive method mix in the context of the crisis.

methodsA longitudinal, mixed-methods study was conducted from May to December 2023. Married, non-pregnant Lebanese and Syrian women aged 18-49 were recruited from three Primary Healthcare Centers (PHCs) and one pharmacy in Beirut. A total of 326 women completed an initial in-person survey and 223 (68.4%) were successfully re-surveyed at four months. In-depth interviews were conducted with a purposive sample of 21 women who experienced a pregnancy or changes in contraceptive use or fertility intentions between the surveys. Quantitative results were analyzed using descriptive statistics and logistic regression models. Qualitative results were analyzed thematically.

resultsOverall, 67% of Syrian participants and 54% of Lebanese participants were using any contraceptive method. Five methods accounted for almost all contraceptive use: intrauterine devices (34%), withdrawal (19%), pills (14%), rhythm (14%), and condoms (12%). While most users of modern methods faced no challenges accessing their method during the crisis, increasing prices were a challenge for users of short-acting methods. Even in the context of the crisis, the most common reason for method choice was (lack of) side effects. Although PHCs facilitated access to affordable contraceptives, they offered limited method choice, particularly longer-acting methods.

conclusionsThe limited method mix provided in Lebanon's PHC system is a barrier to women's ability to exercise informed choice of method. There are few affordable contraceptive options available, such that some women are unable to switch between modern methods that might better suit their needs and preferences. To meet the diverse needs of women throughout their reproductive lives, healthcare facilities and their partners should prioritize expanding the range of contraceptive methods available while implementing key policy changes to improve the accessibility, availability, and quality of reproductive health services.