Contraceptive use in the Gaza Strip: A systematic review

Background: Between 2017-2019, the average total fertility rate in Gaza was 3.9 births per woman, which is significantly higher than the average global total fertility rate at 2.4 births per woman in 2018. Reliable family planning methods allow women and men to avoid unintended pregnancies and reduce maternal mortality. The purpose of this systematic review was to examine what is known about contraceptive use in the Gaza Strip, including: 1) common contraceptive methods used, 2) access to contraceptive services, and 3) barriers impacting family planning services.Methods: The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles published in the English language within the last 10 years (2013 to 2023) were screened from the following databases: CINAHL, PubMed, and Google Scholar.Results: Seven articles were included in the final analysis. The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) was found to be the main family planning service provider in the Gaza Strip (61%). Intrauterine devices (35.4%) were found to be the main method of contraception. Factors identified that impact contraceptive use included: 1) access to contraceptives, 2) cultural beliefs, 3) demographic characteristics (e.g., occupation and education), and 4) healthcare provider (HCP) and system influence. The restriction of goods into the Gaza Strip continues to impact contraceptive accessibility. Educational interventions should focus on addressing contraceptive misconceptions among Gazan women and HCPs while giving special attention to cultural beliefs (e.g., desire for several children) and demographic characteristics, specifically relating to occupation and education status.Conclusion: Unintended pregnancies are preventable through the effective use of contraceptives. Future studies should prioritize interventions aimed at overcoming barriers to contraceptive use in the Gaza Strip, thereby promoting and safeguarding Gazan individuals' ability to exercise their reproductive health rights freely.