title: Social and traditional practices and their implications for family planning: a participatory ethnographic study in Renk, South Sudan.
abstract: BACKGROUND
  Understanding what determines family size is crucial for programmes that aim to provide family planning services during and after conflicts. Recent research found that development agents in post conflict settings do not necessarily take time to understand the context adequately, translate their context understanding into programming, or adjust programming in the light of changes. South Sudan, a country that has been suffering from war for almost 50 years, has one of the highest maternal death rates and the lowest contraceptive utilization rates in the world.
  
  
  METHODS
  This research used Participatory Ethnographic Evaluation and Research (PEER) to provide a contextualised understanding of social and traditional practices and their implications for family planning. Fourteen women were recruited from 14 villages in Renk County in South Sudan in the period 2010-2012. They were trained to design research instruments, conduct interviews, collect narratives and stories and analyse data to identify, prioritize and address their maternal health concerns.
  
  
  RESULTS
  As a result of wars, people are under pressure to increase their family sizes and thus increase the nation's population. This is to compensate for the men perished in war and the high child death rates. Large family size is regarded as a national obligation. Women are caught up in a vicious cycle of high fertility and a high rate of child mortality. Determinants of large family size include: 1) Social and cultural practices, 2) Clan lineage and 3) Compensation for loss of family members. Three strategies are used to increase family size: 1) Marry several women, 2) Husbands taking care of women, and 3) Financial stability. Consequences of big families include: 1) Financial burden, 2) Fear of losing children, 3) Borrowing children and 4) Husband shirking responsibility.
  
  
  CONCLUSIONS
  The desire to have a big family will remain in South Sudan until families realise that their children will live longer, that their men will not be taken by the war, and that the costs of living will be met. In order to generate demand for family planning in South Sudan, priority should be given first to improve infant and child health.
authors.affiliation: Graduate Entry Medical School, University of Limerick, Limerick, V94 T9PX, Ireland. Khalifa_elmusharaf@yahoo.com.|Reproductive & Child Health Research Unit (RCRU), University of Medical Sciences & Technology, Khartoum, Sudan. Khalifa_elmusharaf@yahoo.com.
authors.forename: Khalifa
authors.identifier: http://orcid.org/0000-0001-8652-1867
authors.initials: K
authors.lastname: Elmusharaf
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Elaine
authors.initials: E
authors.lastname: Byrne
authors.affiliation: National University of Ireland Galway, Galway, Ireland.
authors.forename: Diarmuid
authors.initials: D
authors.lastname: O'Donovan
mesh_terms: D000293:Adolescent; D000328:Adult; D055812:Community-Based Participatory Research; D003267:Contraception / Q000706:statistics & numerical data*; D003466:Cultural Characteristics; D003906:Developing Countries; D005191:Family Characteristics; D005193:Family Planning Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012736:Sex Education; D066262:Social Norms; D000068037:South Sudan; D055815:Young Adult
keywords: Conflict affected fragile states; Family planning; Maternal health; South Sudan