{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:47:13Z","timestamp":1782283633809,"version":"3.54.5"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100023206","name":"Canadian Partnership for Women and Children's Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100023206","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Glob. Women\u2019s Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multi-method qualitative study in 2023\u20132024 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fgwh.2026.1776991","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:55:20Z","timestamp":1782280520000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cContraceptives are like committing a crime\u201d: a qualitative study on contraceptive access and utilization in Libya"],"prefix":"10.3389","volume":"7","author":[{"given":"Mariam Omar","family":"Elsaltani","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences, University of Ottawa , , ON","place":["Ottawa, Canada"]},{"name":"Faculty of Public Health, University of Benghazi","place":["Benghazi, Libya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angel M.","family":"Foster","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Ottawa , , ON","place":["Ottawa, Canada"]},{"name":"Collaborative for Interdisciplinary Global Abortion Research","place":["Ottawa, ON, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"B1","year":"2022"},{"key":"B2","year":"2023"},{"key":"B3","year":"2025"},{"key":"B4","year":"2014"},{"key":"B5","year":"2023"},{"key":"B6","volume-title":"Social Assistance Programs and Delivery in Libya","year":"2021"},{"key":"B7","year":"2021"},{"key":"B8","volume-title":"Reforming Health System in Libya","author":"\u00c7elik","year":"2021"},{"key":"B9","year":"2018"},{"key":"B10","volume-title":"Libya Service Availability and Readiness Assessment","year":"2017"},{"key":"B11","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1080\/13625187.2017.1394453","article-title":"Contraception supply chain challenges: a review of evidence from low- and middle-income countries","volume":"22","author":"Mukasa","year":"2017","journal-title":"Eur J Contracept Reprod Health Care"},{"key":"B12","year":"2023"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1773693","DOI":"10.1080\/26410397.2020.1773693","article-title":"Integration of sexual and reproductive health services in the provision of primary health care in the Arab states: status and a way forward","volume":"28","author":"Kabakian-Khasholian","year":"2020","journal-title":"Sex Reprod Health Matters"},{"key":"B14","doi-asserted-by":"publisher","first-page":"380","DOI":"10.2105\/AJPH.93.3.380","article-title":"What is population health?","volume":"93","author":"Kindig","year":"2003","journal-title":"Am J Public Health"},{"key":"B15","volume-title":"Closing the gap in a Generation: Health Equity Through Action on the Social Determinants of Health","year":"2008"},{"key":"B16","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1146\/annurev-lawsocsci-102612-134037","article-title":"Reproductive justice","volume":"9","author":"Luna","year":"2013","journal-title":"Annu Rev Law Soc Sci"},{"key":"B17","year":"2018"},{"key":"B18","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.contraception.2018.03.033","article-title":"Emergency contraception in Albania: a multimethods qualitative study of awareness, knowledge, attitudes and practices","volume":"98","author":"Doci","year":"2018","journal-title":"Contraception"},{"key":"B19","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/j.contraception.2019.10.002","article-title":"Emergency contraception in Jordan: assessing retail pharmacists\u2019 awareness, opinions, and perceptions of need","volume":"101","author":"El-Mowafi","year":"2020","journal-title":"Contraception"},{"key":"B20","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1111\/j.1728-4465.2016.00047.x","article-title":"Emergency contraception in post-conflict Somalia: an assessment of awareness and perceptions of need","volume":"47","author":"Gure","year":"2016","journal-title":"Stud Fam Plann"},{"key":"B21","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.contraception.2019.09.008","article-title":"Assessing the availability and accessibility of emergency contraceptive pills in Uganda: a multi-methods study with Congolese refugees","volume":"101","author":"Nara","year":"2020","journal-title":"Contraception"},{"key":"B22","doi-asserted-by":"publisher","first-page":"194","DOI":"10.5539\/gjhs.v8n11p194","article-title":"Dynamics shaping access to reproductive health services in peri-urban Yangon, Myanmar: a multi-methods study","volume":"8","author":"Sheehy","year":"2016","journal-title":"Glob J Health Sci"},{"key":"B23","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1111\/mepo.12560","article-title":"The regional origins of the Libyan conflict","volume":"28","author":"Grigoriadis","year":"2021","journal-title":"Middle East Policy"},{"key":"B24","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1177\/1440783307073931","article-title":"To be or not to be a mother?: women negotiating cultural representations of mothering","volume":"43","author":"Maher","year":"2007","journal-title":"J Sociol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1875","DOI":"10.1111\/bjso.12661","article-title":"The mother of violations: motherhood as the primary expectation of women","volume":"62","author":"Szekeres","year":"2023","journal-title":"Br J Soc Psychol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"103614","DOI":"10.1016\/j.actpsy.2022.103614","article-title":"Intensive mothering and the perpetuation of gender inequality: evidence from a mixed methods research","volume":"227","author":"Verniers","year":"2022","journal-title":"Acta Psychol (Amst)"},{"key":"B27","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1186\/s12884-023-05408-9","article-title":"Revisiting fertility regulation and family ties in Tunisia","volume":"23","author":"Frini","year":"2023","journal-title":"BMC Pregnancy Childbirth"},{"key":"B28","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s41118-024-00217-0","article-title":"Gender composition of children and desires for the next child in \u201cson preference\u201d countries","volume":"80","author":"Kazenin","year":"2024","journal-title":"Genus"},{"key":"B29","doi-asserted-by":"publisher","first-page":"S118","DOI":"10.1086\/685762","article-title":"What explains patrilineal cooperation?","volume":"57","author":"Strassmann","year":"2016","journal-title":"Curr Anthropol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"101146","DOI":"10.1016\/j.ehb.2022.101146","article-title":"Conflicts and son preference: micro-level evidence from 58 countries","volume":"46","author":"Goli","year":"2022","journal-title":"Econ Hum Biol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"100623","DOI":"10.1016\/j.ssmqr.2025.100623","article-title":"Protectors or perpetrators? The paradox of male guardianship and gender-based violence in Libya: a multi-method qualitative study","volume":"8","author":"Omar Elsaltani","year":"2025","journal-title":"SSM Qual Res Health"},{"key":"B32","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1783\/147118910790291019","article-title":"Approaches to family planning in muslim communities","volume":"36","author":"El Hamri","year":"2010","journal-title":"J Fam Plann Reprod Health Care"},{"key":"B33","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/s12978-020-0888-1","article-title":"Factors influencing sexual and reproductive health of muslim women: a systematic review","volume":"17","author":"Alomair","year":"2020","journal-title":"Reprod Health"},{"key":"B34","first-page":"613","article-title":"Abraham, abortion, and Abbott's Texas: how the Texas trigger law disproportionately burdens the religious freedoms of Muslim women","volume":"61","author":"Haj-Maharsi","year":"2024","journal-title":"Hous Law Rev"},{"key":"B35","doi-asserted-by":"publisher","first-page":"5","DOI":"10.3390\/rel12010005","article-title":"How religion, social class, and race intersect in the shaping of young women's understandings of sex, reproduction, and contraception","volume":"12","author":"Krull","year":"2021","journal-title":"Religions (Basel)"},{"key":"B36","year":"1953"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1080\/07399332.2016.1234857","article-title":"A spotlight on reproductive coercion","volume":"37","author":"Anderson","year":"2016","journal-title":"Health Care Women Int"},{"key":"B38","volume-title":"Conceiving the new World Order: The Global Politics of Reproduction","author":"Ginsburg","year":"1995"},{"key":"B39","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1080\/01459740.2018.1555829","article-title":"Reproductive governance, redux","volume":"38","author":"Morgan","year":"2019","journal-title":"Med Anthropol"},{"key":"B40","doi-asserted-by":"publisher","first-page":"e24231","DOI":"10.5812\/ircmj.24231","article-title":"The stigma of reproductive health services utilization by unmarried women","volume":"18","author":"Mohammadi","year":"2016","journal-title":"Iran Red Crescent Med J"},{"key":"B41","doi-asserted-by":"publisher","first-page":"371","DOI":"10.9745\/GHSP-D-19-00130","article-title":"Provider bias in family planning services: a review of its meaning and manifestations","volume":"7","author":"Solo","year":"2019","journal-title":"Glob Health Sci Pract"},{"key":"B42","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1186\/s12978-015-0046-3","article-title":"The true cost of maternal death: individual tragedy impacts family, community and nations","volume":"12","author":"Miller","year":"2015","journal-title":"Reprod Health"},{"key":"B43","volume-title":"Infertility and Patriarchy: The Cultural Politics of Gender and Family Life in Egypt","author":"Inhorn","year":"1996"}],"container-title":["Frontiers in Global Women's Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgwh.2026.1776991\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:55:22Z","timestamp":1782280522000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgwh.2026.1776991\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":43,"alternative-id":["10.3389\/fgwh.2026.1776991"],"URL":"https:\/\/doi.org\/10.3389\/fgwh.2026.1776991","relation":{},"ISSN":["2673-5059"],"issn-type":[{"value":"2673-5059","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]},"article-number":"1776991"}}