“Contraceptives are like committing a crime”: a qualitative study on contraceptive access and utilization in Libya
Résumé
Introduction: Contraceptive access is a critical component of sexual and reproductive health and rights, as well as an indicator of health system performance and broader commitments to gender equity. While global frameworks like Family Planning 2030 emphasize the need for equitable and rights-based access to contraception, Libya's centralized yet fragmented health system, compounded by political instability and weak national monitoring, has contributed to gaps in contraceptive service delivery and limited understanding of how women navigate access in practice. This study examines women's contraceptive decision-making in Libya, and the social, political, and institutional factors that shape women's access to and use of contraceptive methods. Methods: We conducted a multi-method qualitative study in 2023-2024 in three major cities in Libya: Tripoli, Benghazi, and Sabha. We conducted 17 in-depth interviews with women of reproductive age, 9 focus group discussions with 60 women, and 11 key informant interviews with healthcare providers and program managers. We analyzed these data sources for content and themes using an iterative approach. Results: Three intersecting themes emerged: 1) Intense societal and familial pressure to bear children, especially sons, exists; 2) The politicization and moral scrutiny of contraception in Libya leads to conditional and uneven access; and 3) Women covertly navigate contraceptive use as a result of risk and stigma. Contraception was more socially tolerated when framed through marriage, spacing, or religiously acceptable purposes, while other forms of use were more heavily scrutinized. Despite persistent barriers, some women described making pragmatic reproductive decisions in response to economic hardship and ongoing instability. Discussion: Efforts to improve contraceptive access in Libya must move beyond availability toward inclusive, system-strengthening, and rights-based approaches that acknowledge normative and structural barriers. Our findings show that in Libya, contraceptive access is shaped not only by health system gaps, but also by the conditional social and political acceptability of contraception.
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