Abstract
BACKGROUND: The Mahama camp was established in 2015 to accommodate displaced populations from different countries, including Burundi, the Democratic Republic of Congo, and Rwanda. The camp, located in Rwanda's Eastern Province, Kirehe District, spans 50 hectares and encompasses 18,360 households across 15 villages. The prevalence of adolescent pregnancy in the Mahama camp was alarming at the time of the study, despite multiple campaigns by the government and international partners, underscoring the complexity of the problem and the need for further research. This study identified factors influencing the accessibility of contraceptives for adolescent refugee girls in Mahama camp in 2022, from the perspective of girls aged 10–19, to inform the design of interventions based on insights gained from the social cognitive theory. METHODS: We undertook in-depth interviews using a semi-structured guide with 19 adolescent girls aged 10–19 years. Participants were selected to represent diverse socio-demographic characteristics, including in-school and out-of-school girls, married and unmarried girls, and those who have or have not ever been pregnant. Data were analysed thematically using the Social Cognitive Theory to identify barriers and facilitators to accessing contraceptive services in the Mahama refugee camp. RESULTS: Enablers of access to contraceptive services included free service provision and support from healthcare providers. Furthermore, community awareness campaigns, convenient service locations, and knowledge about contraception also played an important role. Barriers to access included cultural and religious norms, fear, and misconceptions, as well as camp-specific challenges such as limited funding, shortages of contraceptives, and too few service providers. CONCLUSION: Improving adolescents’ access to contraceptive services in the Mahama Refugee Camp requires coordinated action among key stakeholders, including the government, international partners, and the Mahama camp community. All these stakeholders require a joint effort to ensure consistent availability of contraceptives at youth-friendly and safe service points, alongside expanded and amplified community awareness programs. Furthermore, it is essential to improve efforts to address the shortage of supplies and human resources. The shortage of healthcare workers and revising age-based legal restrictions would further improve adolescents’ access to contraceptive services, which also need to be addressed.