"I don't want my marriage to end" - A qualitative investigation of the sociocultural factors influencing contraceptive use among married Rohingya women residing in refugee camps in Bangladesh

Background: The timely provision of comprehensive contraceptive services to Rohingya women is impeded due to a lack of clarity and understanding of their traditional beliefs and cultural frameworks. Recognizing this challenge, our aim is to explore the socio-cultural factors that influence the utilization of contraceptives among married Rohingya women living in the refugee camps of Cox's Bazar, Bangladesh. Method: A qualitative study was conducted in two unregistered Rohingya camps (Camp7&14) located in Ukhiya Upazila, Cox's Bazar from January 10th to January 20th, 2022. A total of 14 In-Depth Interviews (IDIs) were administered among married Rohingya refugee women of reproductive age (15-49), and 16 Key Informant Interviews (KIIs)were conducted with stakeholders involved in reproductive healthcare provision. The selection of participants was executed through purposive sampling. All interviews were conducted in the local language, recorded, transcribed verbatim, and subsequentlytranslated into English. The data were analyzed using NVivo (Version 11), and the analysis process followed the Neuman three-phase coding system. Results: : Five broad themes were identified:Sociocultural expectations and values attached to births, power imbalances within marital relationships, the role of religious beliefs, fear of side effects, and misperceptions about contraception. Having a larger number of children is viewed positively as it is believed that children play a crucial role in preserving the lineage and contributing to the growth of the Islamic population. Despite expressing an inclination towards contraception, the disapproval of husbands becomes a significant barrier for women. Defying their husbands' wishes can result in instances of intimate partner violence (IPV) and even marriage dissolution within the camps. Moreover, the fear of side effects, such as a particular method would cause infertility, discourages women from using contraception. Many of these fears stem from myths, misconceptions and mistrust in the existing medical system. Conclusion: Addressing the socio-cultural barriers that prevent women from using modern contraception will have important public health implications. These findings can support policymakers, civil society organizations, and health providers in crafting culturally sensitive programs and educational interventions. These efforts can aid Rohingya refugee women in surmounting the identified barriers to contraception.