{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T17:11:16Z","timestamp":1769361076752,"version":"3.49.0"},"reference-count":49,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,8,22]],"date-time":"2022-08-22T00:00:00Z","timestamp":1661126400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Studies in Family Planning"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Sierra Leone was highly impacted by the 2014\u20132016 West Africa Ebola outbreak, with 3,955 recorded deaths. Already stressed maternal health services were deeply affected by the outbreak due to fears of viral transmission, reallocation of maternity staff, and broader policies to stop transmission including travel restrictions. This research sought to explore women's perspectives on delaying pregnancy during the Ebola outbreak using family planning methods. Qualitative data collection took place in Kambia District in 2018 and included 35 women participants, with women who were either family planning users or nonusers at the time of the outbreak. Women reported a variety of reasons for choosing to take or not to take family planning during the outbreak, which we categorized as proximal (directly related to the outbreak) or distal (not directly outbreak related). Proximal reasons to take family planning included to avoid interacting with health care spaces where Ebola could be transmitted, to avoid the economic burden of additional children in a time when economic activities were curtailed and to return to school when education resumed postoutbreak. Distal reasoning included gender roles affecting women's decision making to seek family planning, concerns related to the physiological side effects of family planning, and the economic burden of paying for family planning. Women's perspectives for choosing to take or not take family planning during the Sierra Leone Ebola crisis had not been explored prior to this paper. Using the lens of family planning to consider how women choose to access health care in an outbreak gives us a unique perspective into how all health care interactions are impacted by a generalized outbreak of Ebola, and how outbreak responses struggle to ensure such services remain a priority.<\/jats:p>","DOI":"10.1111\/sifp.12210","type":"journal-article","created":{"date-parts":[[2022,8,22]],"date-time":"2022-08-22T17:44:15Z","timestamp":1661190255000},"page":"575-593","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Family Planning in the Sierra Leone Ebola Outbreak: Women's Proximal and Distal Reasoning"],"prefix":"10.1111","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1510-9212","authenticated-orcid":false,"given":"Gillian","family":"McKay","sequence":"first","affiliation":[{"name":"Department of Global Health and Development The London School of Hygiene and Tropical Medicine  15\u201017 Tavistock Place London WC1H 9SH UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6336-6531","authenticated-orcid":false,"given":"Luisa","family":"Enria","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development The London School of Hygiene and Tropical Medicine  15\u201017 Tavistock Place London WC1H 9SH UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1941-4265","authenticated-orcid":false,"given":"Sara L.","family":"Nam","sequence":"additional","affiliation":[{"name":"Independent Consultant"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maseray","family":"Fofanah","sequence":"additional","affiliation":[{"name":"Independent"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suliaman Gbonnie","family":"Conteh","sequence":"additional","affiliation":[{"name":"University of Sierra Leone College of Medicine and Allied Health Sciences  A. 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Momoh Street Tower Hill Freetown Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0062-7930","authenticated-orcid":false,"given":"Shelley","family":"Lees","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development The London School of Hygiene and Tropical Medicine  15\u201017 Tavistock Place London WC1H 9SH UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,8,22]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.5040\/9781350225701.ch-005"},{"key":"e_1_2_10_3_1","volume-title":"Women's Resilience: Integrating Gender in the Response to Ebola","author":"African Development Bank","year":"2016"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1353\/dem.2002.0013"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/sifp.12110"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471\u20100528.13232"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/1753495x15597354"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh\u20102020\u2010003675"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31679-2"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.2017.304260"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.4324\/9780203361832"},{"issue":"51","key":"e_1_2_10_12_1","first-page":"1226","article-title":"Perceptions of the Risk for Ebola and Health Facility Use among Health Care Workers and Pregnant and Lactating Women \u2010 Kenema District, Sierra Leone, September 2014","volume":"63","author":"Dynes M","year":"2015","journal-title":"Morbidity and Mortality Weekly Report"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.17157\/mat.5.4.512"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.5040\/9781350225701.ch-007"},{"key":"e_1_2_10_15_1","first-page":"299","article-title":"Introduction: Blood Mysteries: Beyond Menstruation as Pollution","author":"Hoskins Janet.","year":"2002","journal-title":"Ethnology"},{"key":"e_1_2_10_16_1","unstructured":"Inter\u2010Agency Standing Committee Reference Group for Gender in Humanitarian Action.2015. \u201cHumanitarian Crisis in West Africa (Ebola) Gender Alert.\u201d UN Women. 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