Predictors of Access to Sexual and Reproductive Health Services by Urban Refugees in Kampala City, Uganda

Abstract

Mukama Semei Christopher, Susan Nakubulwa, Esperance Nyirabega, Pallen Mugabe, Joseph Baruch Baluku, Mary Odiit, Harriet Chemusto, Erna Snelgrove-Clarke, Noni MacDonald, Robert Bortolussi, Janice Graham, Barbara Mukasa

Background: The influx of over 1.3 million refugees in Uganda, with 80,000 settling in the capacity city Kampala (16), challenges the ability of urban refugees to access Sexual and Reproductive Health services (SRH) and family planning (FP) amidst the multiple uncertainties of a precarious everyday life. Utilization of SRH services remains low among urban refugees even though these services are essential to those of reproductive age and vulnerable to unwanted pregnancies and its consequences and contracting sexually transmitted infections (STIs) including HIV. Mild may-Uganda conducted a multimethod outreach program to establish the predictors of access to SRH services by urban refugees in Kampala city this paper presents.

Methods: A participatory, gender based, community-led, empowerment approach called Gender Action Learning Systems (GALS) was employed to deliver SRH including FP services to urban refugees in Kampala for 2 years. Urban refugees enrolled in GALS were interviewed at the beginning and end of the GALS intervention and quantitative data was collected. Univariate, bivariate, and multivariate analyses were conducted to determine social demographic factors influencing the uptake of SRH services by urban refugees.

Results: The study enrolled 867 participants, with 605 completing the study. Median age was 29 (IQR:22-36) years. There were significant associations between SRH use and age, religion, and education level among the urban refugees. Pentecostal were more likely to take up FP compared to Muslims (Adjusted OR (AOR) 7.9; 95% Confidence Interval (CI) 3.5-18) and those who had primary education were 5 times more likely to use FP compared to those who had no formal education (AOR 5.2; 95% CI 1.5 – 18). Adults aged 20 to 49 years were more likely to use FP compared to adolescents aged 15 to 19 years at both baseline (AOR 6.6; 95% CI 2.7-17) and endpoint (AOR 11; 95% CI 3.4 -36).

Conclusion: Strategies to identify emancipated adolescents among refugees and support them to utilize family planning services need to be designed to successfully integrate newcomers into Uganda’s general healthcare services.

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