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Maternal Health Care Utilization Among Syrian Refugees in Lebanon and Jordan


Purpose The influx of Syrian refugees into Jordan and Lebanon over the last 5 years presents an immense burden to national health systems. This study was undertaken to assess utilization of maternal health services among Syrian refugees in both countries. Description A cross-sectional survey of Syrian refugees living in urban and rural (non-camp) settings was conducted using a two-stage cluster survey design with probability proportional to size sampling in 2014–2015. Eighty-six percent of surveyed households in Lebanon and 88% of surveyed households in Jordan included women with a live birth in the last year. Information from women in this sub-set of households was analyzed to understand antenatal and intrapartum health service utilization. Assessment A majority of respondents reported seeking antenatal care, 82% and 89% in Jordan and Lebanon, respectively. Women had an average of at least six antenatal care visits. Nearly all births (98% in Jordan and 94% in Lebanon) took place in a health facility. Cesarean rates were similar in both countries; approximately one-third of all births were cesarean deliveries. A substantial proportion of women incurred costs for intrapartum care; 33% of Syrian women in Jordan and 94% of Syrian women in Lebanon reported paying out of pocket for their deliveries. The proportion of women incurring costs for intrapartum care was higher in Jordan both countries for women with cesarean deliveries compared to those with vaginal deliveries; however, this difference was not statistically significant in either country (Jordan p-value = 0.203; Lebanon p-value = 0.099). Conclusion Syrian refugees living in Jordan and Lebanon had similar levels of utilization of maternal health services, despite different health systems and humanitarian assistance provisions. As expected, a substantial proportion of households incurred out-of-pocket costs for essential maternal and newborn health services, making cost a major factor in care-seeking decisions and locations. As health financing policies shift to account for the continued burden of refugee hosting on the health system, sustained attention to the availability and quality of essential maternal and newborn health services is needed to protect both refugee and host populations women’s rights to health and health care during pregnancy, childbirth, and the postpartum period.

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Both surveys were implemented by the Center for Humanitarian Health at Johns Hopkins School of Public Health (JHSPH). The Jordan survey was also implemented by the School of Nursing at Jordan University for Science and Technology (JUST) and the Lebanon survey by Médecins du Monde (MdM). Technical support for the Jordan survey was provided by the World Health Organization (WHO), and the Ministry of Health (MoH) of the Hashemite Kingdom of Jordan. Administrative and technical support for the Lebanon survey was provided by International Medical Corps, the American University of Beirut Faculty of Health Sciences. The United Nations High Commissioner for Refugees (UNHCR) provided technical support for both studies. The study team would like to acknowledge Gilbert Burnham and William Weiss from JHSPH and Arwa Oweis and Laila Akhu-Zaheya from JUST for their many contributions to study design and implementation. We also extended our gratitude to the JUST and MdM interviewers, without whom this work would not have been possible. Finally, we would like to acknowledge Rick Brennan, Claudine Prudhon, Altaf Musani, Basel Al-Yousfi, Miranda Shami, Mary Sweidan and Said Aden from WHO and Paul Spiegel, Marian Schilperoord, Michael Woodman, and Frank Tyler from the UNHCR for their support and efforts to facilitate the survey.


The Jordan study was funded by the World Health Organization and the Lebanon study was funded by the European Commission Humanitarian Aid and Civil Protection Department.

Collaborators for the Jordan Health Access Study Team

including Arwa Oweis, Laila-Akhu Zaheya, Timothy Roberton, Gilbert Burnham and William Weiss.

Collaborators for the Lebanon Health Access Study Team

including Baptiste Hanquart, Lara Chela, Nour Aridi, Nour Kassab, Aline Keyrouz, Deena Al-Shatti, Francois de La Roche and Michael Woodman.

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Correspondence to Shannon Doocy.

Additional information

Collaborators of the of the Jordan Health Access Study Team and Lebanon Health Access Study Team Working Groups are listed in “Acknowledgment”.

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Tappis, H., Lyles, E., Burton, A. et al. Maternal Health Care Utilization Among Syrian Refugees in Lebanon and Jordan. Matern Child Health J 21, 1798–1807 (2017).

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  • Syria
  • Jordan
  • Lebanon
  • Refugee
  • Humanitarian assistance
  • Maternal health
  • Antenatal care
  • Intrapartum care
  • Cesarean