Fragmented Care and Unmet Needs: A Multi-methods Study of Sexual and Reproductive Health Services in Libya.

OBJECTIVES

Prolonged conflict and political instability have severely strained Libya's healthcare system, creating significant gaps in sexual and reproductive health (SRH) services. We aimed to assess the availability and accessibility of comprehensive SRH services in three regions of Libya and identify avenues for improvement.

METHODS

We conducted this multi-methods qualitative study in Benghazi, Sabha, and Tripoli. Our research included a desk review, a service mapping exercise, 16 in-depth interviews with women of reproductive age, nine focus group discussions involving 60 women, and 11 key informant interviews with healthcare providers, policymakers, and non-governmental organization representatives. We analyzed these data for content and themes using deductive and inductive techniques and triangulated the results.

RESULTS

Sexual and reproductive health services are centralized in urban hospitals, leading to overcrowding and limited access in other geographic areas. Although pregnancy and delivery services are available, family planning programs are limited, emergency contraception is virtually absent, and abortion services are restricted to life-threatening cases. Cultural stigma, workforce shortages, disorganized referrals, and government hostility exacerbate barriers to care. Many women turn to the private sector, which is costly and often inadequate for their complex needs.

CONCLUSIONS FOR PRACTICE: We highlight critical gaps in Libya's SRH service delivery landscape, driven by systemic, infrastructural, and cultural barriers. Decentralizing services, strengthening referral systems, addressing cultural stigma, and improving government responsiveness are essential for advancing equitable access to SRH care and improving health outcomes for Libyan women. Future research should explore long-term strategies to address these challenges in this conflict-affected and fragile setting.