Strategies for sustaining sexual and reproductive health services during recurrent flooding in Adamawa State, Nigeria. A qualitative study.

Seasonal flooding in Adamawa State, Nigeria damages health facilities, breaks supply chains, and displaces health workers and communities, while increasing health needs. Sexual and reproductive health (SRH) services are often deprioritized, yet evidence on how they are sustained remains limited. We examined how SRH services were sustained during recurrent flooding. We conducted a qualitative descriptive study in the flood-prone Local Government Areas of Numan and Fufore. We held eight focus group discussions with women and girls and 20 key informant interviews with health providers, supply chain actors, and program implementers. Flooding closed or damaged health facilities, broke supply and cold chains, and displaced health workers. Participants linked these disruptions to unattended births and to rising hemorrhage, stillbirth, miscarriage, and genital infections. Service continuity depended less on the formal health system than on anticipatory, community-led adaptation across three phases. Before floods, stakeholders mapped risk, pre-positioned commodities, trained women in contraceptive self-injection, and dispensed medicines in advance. During floods, care shifted to mobile outreach, task-sharing, transport by canoe and boat, and community-led referral. Community health workers, traditional birth attendants, Ward Development Committees, and women's groups reached cut-off communities. Across seasons, adaptations evolved toward cash transfers, savings groups, local reusable-pad production, and decentralized commodity hubs. Continuity relied heavily on unpaid community labor and women's own resources. Sustaining SRH services in flood-prone settings requires institutionalized preparedness, decentralized supply, empowered communities, and protected health financing. Community-led models offer a transferable approach to health security in a changing climate.