Key Social Norms Take-aways This study reveals how deeply rooted patriarchal and cultural norms among South Sudanese refugee communities in Uganda severely restrict women’s and girls’ contraceptive autonomy. Social norms idealize large families, associate contraception with promiscuity, and reinforce male dominance in reproductive decision-making. Fear of community backlash, intimate partner violence, and the loss of social support deter women from openly using contraceptives. Myths, misconceptions, and the perceived link between contraception and infertility or birth defects exacerbate stigma. The study emphasizes that addressing these gendered norms and power imbalances through community-based strategies is critical to improving reproductive health outcomes in humanitarian settings.
Objectives The study aimed to explore the barriers to contraceptive use among South Sudanese refugee women living in Adjumani district, Uganda, with a focus on gender dynamics, cultural and religious norms, and institutional constraints.
Methods An exploratory qualitative design was used, drawing on the ecological model to assess intrapersonal, interpersonal, community, and institutional influences on contraceptive use. Data were collected through four focus group discussions and fourteen in-depth interviews with 46 women aged 15–49 across three refugee settlements. Transcripts were coded using Atlas.ti, and content analysis was applied to identify key themes.
Results Barriers to contraceptive use spanned multiple levels. Intrapersonally, low education and limited access to contraceptive information reduced women’s ability to make informed decisions. Interpersonally, male dominance, gendered power imbalances, and fear of reprisal—including violence, neglect, or divorce—forced many women to use contraceptives covertly or not at all. Women also reported being viewed as promiscuous if they used contraception, especially adolescents. At the community level, social norms prioritized large families for economic and cultural reasons (e.g., bride price), while myths about side effects and infertility discouraged uptake. Leaders often promoted pro-natalist views, undermining reproductive health programming. Institutionally, unclear policies on adolescent access, poor service quality, and limited contraceptive options further hindered use.
Conclusions To address the significant barriers to contraceptive use in humanitarian settings, interventions must go beyond health services to directly challenge harmful social norms and gendered power structures. Community-driven strategies that engage both men and women, acknowledge local values, and support women’s empowerment are essential. Policies must be clarified to support adolescent access, and service delivery should be improved to ensure safety, confidentiality, and informed choice.