Determinants of Family Planning Service Utilization among Palestine Refugees at UNRWA Health Center in Amman, Jordan: A Qualitative and Quantitative Mixed-Methods Study

Debora  Kim; Zachrieh  Alhaj; Zaid  Almubaid; Esther  Jeong; Salem  Khalil; Daniel F  Young; Andrew  Thorntoni; Hani  Serag

doi:10.18502/jbe.v11i2.20555

Debora Kim John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States.
Zachrieh Alhaj John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States.
Zaid Almubaid John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States.
Esther Jeong John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States.
Salem Khalil John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States.
Daniel F Young John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States.
Andrew Thorntoni John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States.
Hani Serag Department of Public Health, University of Texas Medical Branch, Galveston, Texas, United States.

DOI: https://doi.org/10.18502/jbe.v11i2.20555

Keywords: Family planning; Women’s health; Jordan; Refugee health; Epidemiology

Abstract

Introduction: Family planning is a vital aspect of reproductive health, encompassing contraceptive use, pregnancy, and prevention of sexually transmitted infections (STI). Among Palestine refugees in Jordan, particularly those utilizing services by The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), maternal mortality rates and contraceptive use highlight the urgent need to address gaps in family planning service utilization. Sociocultural factors and systemic barriers remain determinants of contraceptive use and family planning outcomes in this population.

Methods: A mixed-methods study was conducted from June 5–7, 2023, at a single UNRWA health center in Marka camp located in Amman, Jordan. The study involved structured interviews with 57 female participants, focus group discussions (FGDs) among participants, and semi-structured interviews with healthcare providers at Marka health center. Quantitative data collection encompassed sociodemographic factors, perceptions of family planning services, and sociocultural determinants influencing contraceptive use. Categorical variable findings were analyzed by frequency and proportions. Subsequently, an exploratory descriptive approach was taken to gather qualitative data via FGD and semi-structured interviews. Transcripts from FGDs and interviews were coded and synthesized by thematic analysis to identify salient determinants of family planning knowledge, perceived barriers and self-efficacy to find access to family planning services.

Results: Major findings reported include: (1) Internet and health care professionals are cited as primary sources of knowledge regarding family planning with the most common reason for choosing the preferred contraception being professional advice (22.2%), (2) Sociocultural factors significantly shaped decisions, with a majority of FGD participants citing spousal preferences as the key determinant, and (3) Perceptions of UNRWA’s services were largely positive, with 98.2% rating them excellent or good. However, logistical challenges such as long wait times and transportation costs were frequently reported as barriers. These challenges did not seem to diminish the overall satisfaction for patients, but did hinder utilization of services.

Conclusion: While UNRWA’s family planning services are well-regarded, persistent barriers such as sociocultural constraints, limited knowledge, and service accessibility require targeted interventions. Fostering supportive sociocultural environments and improving logistical factors like wait times can enhance service uptake. Future research should explore long-term impacts of family planning initiatives and expand the scope to include other UNRWA health centers to inform inclusive and effective health policies pertaining to reproductive health in this low-income setting.