Navigating women's reproductive health and childbearing during public health crises: Covid-19 and Zika in Brazil

Changes in contraceptive use during the second COVID-19 lockdown in Brazil: A web-based survey

OBJECTIVE

We assessed contraceptive use changes during the second lockdown due to COVID-19 in Brazil and their associated factors.

STUDY DESIGN

This was a longitudinal web-based study in which 725 non-pregnant Brazilian women aged 18 to 49 completed an online structured survey about their contraceptive practices in two rounds in 2021. Multivariate multinomial logistic regression was used to analyze factors associated with contraceptive use changes during COVID-19.

RESULTS

Sixty percent reported they changed their contraceptive use during COVID-19, especially starting to use a method or switching to a more effective one (32%). In adjusted analysis, women who were ambivalent about a future pregnancy were more likely to switch to a more effective method (adjusted odds ratio [aOR] 2.33, 95% CI 1.42-3.83) and to stop using contraceptive (aOR 3.64, 95% CI 1.91-6.91). Women with a partner were less likely to switch to a more effective method (aOR 0.61, 95% CI 0.39-0.93) and to stop using contraceptive (aOR 0.53, 95% CI 0.31-0.93), but more likely to switch to a less effective method (aOR 2.25, 95% CI 1.16-4.34). Age was also associated with contraceptive use changes.

CONCLUSIONS

Contraceptive use among Brazilian women during COVID-19 depended on their age and partnership status. During the period of the highest peak in the number of cases and deaths in the country, ambivalence towards a future pregnancy increased changes in contraceptive use.

IMPLICATIONS

Contraceptive changes were observed during a two-wave web-survey in Brazil depending on women's age and partnership status. Ambivalence towards a future pregnancy increased changes in contraceptive use and should be considered in future studies regarding sexual and reproductive health and COVID-19 as well as in family planning program implementation.

Childcare burden and changes in fertility desires of mothers during the COVID-19 pandemic

Objectives

Previous studies have documented a decline in fertility desires and intentions following the COVID-19 outbreak, but the reasons for this decline are not well understood. This study examined whether childcare burden on mothers during the lockdown and quarantines, COVID-related stress, and COVID exposure were associated with a change in the desired number of children.

Methods

The survey was conducted online, in Poland from April to July 2021 on a sample of 622 non-pregnant mothers without diagnosed infertility.

Results

Associations were observed between childcare responsibilities during the quarantine and fertility desires: mothers who solely or mainly took care of their children during the quarantine(s) were more likely to decrease their desired number of children ([adjusted] aOR = 1.91, 95% CI = 1.16-3.15). Mothers with higher levels of COVID-related stress (aOR = 1.81, 95% CI = 1.48-2.22) and a greater COVID exposure index (aOR = 1.39, 95% CI = 1.12-1.72) were more likely to decrease their fertility desires.

Conclusion

Higher childcare burden during quarantines was related to a lower desired number of children among mothers. Both greater COVID-related stress and COVID exposure were associated with fertility desires, regardless of childcare responsibilities during the pandemic.

Women's Attitudes Towards Abortion in Response to the Zika and COVID-19 Outbreaks in Brazil

Introduction

Abortion attitudes are influenced by people's socioeconomic and demographic circumstances and can be volatile during times of crisis. Brazil is an interesting case for examining abortion attitudes because of its strict abortion policies, changing religious landscape, high income inequality, and extreme uncertainty generated by the back-to-back Zika and COVID-19 crises. This study seeks to assess Brazilian women's attitudes toward abortion and whether religion and income explain these attitudes in the context of novel infectious disease epidemics.

Methods

We used data from a population-based sample of 3996 women ages 18-34 in Pernambuco, Brazil, collected during the onset of the COVID-19 pandemic (May-September 2020). We conducted paired t-tests and multivariate-adjusted logistic regression models with adjusted Odds Ratios (aORs) and 95% CIs to assess differences in support for abortion in the case of fetal congenital Zika syndrome (CZS), maternal Zika infection during pregnancy, and maternal COVID-19 infection during pregnancy.

Results

Significantly more women support the right to abortion in the case of fetal CZS (50%) than in the case of maternal Zika infection (40%) and maternal COVID-19 infection (31%). Support for abortion varies by income and religion. Controlling for other demographic characteristics, high-income women have higher odds of supporting abortion in the case of fetal CZS (aOR = 1.92; 95% CI: 1.25-2.94) and maternal Zika infection (aOR = 2.07; 95% CI: 1.33-3.21) than low-income women. Evangelical women have lower odds of supporting abortion in the case of maternal Zika infection (aOR = 0.65; 95% CI: 0.45-0.93) and marginally lower odds of supporting the right to abortion in the case of maternal COVID-19 infection (aOR = 0.69; 95% CI: 0.47-1.00) than women of other religious affiliations.

Conclusions and Policy Implications

With increasingly conservative religious groups gaining size in Brazil, we expect to see increasing abortion restrictions. However, this research finds that a sizable portion of women across all incomes and religious affiliations support abortion, particularly in the case of fetal anomalies associated with Zika.

Childbearing decisions and related factors in the COVID-19 pandemic: A narrative review study

The COVID-19 pandemic has had considerable consequences in many areas of life, including the social area and childbearing plans. The present narrative review aimed to examine the childbearing decisions and its related factors during the COVID-19 pandemic. This review was conducted by searching in scientific databases, including Web of Science, Science Direct, Google Scholar, Scopus, Cochrane, PubMed, ProQuest, Scientific Information Database (SID), Iranian Research Institute for Information Science and Technology (IranDoc) and Iranian Journal Database (Magiran) in June 2022. The search resulted in 111 sources, of which 16 were in line with the research objective. Couples have mainly cancelled or delayed their previous plans related to childbearing decisions. There are two groups of direct and indirect factors related to childbearing decisions during the COVID-19 pandemic: The former includes (1) well-being-related factors such as economic conditions, interpersonal relationships and gender roles in terms of task division; and (2) health-related factors, including health emergencies and physical and psychological health. The latter includes factors such as social distancing and social media. Based on the results, governments should facilitate childbearing by adjusting existing policies, addressing economic insecurity and protecting the livelihoods of those affected by the crisis. Health policymakers and planners must also prioritize women's access to reproductive health services in a safe environment while promoting equity in access. It is also necessary to promote the quality and quantity of indirect care and virtual counseling based on the needs of women in crisis.

Impacts of COVID-19 on contraceptive and abortion services in low- and middle-income countries: a scoping review

The COVID-19 pandemic has disproportionate effects on people living in low- and middle-income countries (LMICs), exacerbating weak health systems. We conducted a scoping review to identify, map, and synthesise studies in LMICs that measured the impact of COVID-19 on demand for, provision of, and access to contraceptive and abortion-related services, and reproductive outcomes of these impacts. Using a pre-established protocol, we searched bibliographic databases (December 2019-February 2021) and key grey literature sources (December 2019-April 2021). Of 71 studies included, the majority (61%) were not peer-reviewed, and 42% were based in Africa, 35% in Asia, 17% were multi-region, and 6% were in Latin America and the Caribbean. Most studies were based on data through June 2020. The magnitude of contraceptive service-related impacts varied widely across 55 studies (24 of which also included information on abortion). Nearly all studies assessing changes over time to contraceptive service provision noted declines of varying magnitude, but severe disruptions were relatively uncommon or of limited duration. Twenty-six studies addressed the impacts of COVID-19 on abortion and postabortion care (PAC). Overall, studies found increases in demand, reductions in provision and increases in barriers to accessing these services. The use of abortion services declined, but the use of PAC was more mixed with some studies finding increases compared to pre-COVID-19 levels. The impacts of COVID-19 varied substantially, including the country context, health service, and population studied. Continued monitoring is needed to assess impacts on these key health services, as the COVID-19 pandemic evolves.

Fertility trends during successive novel infectious disease outbreaks: Zika and COVID-19 in Brazil

This study aims to estimate fertility trends in Brazil in the 2010s and early 2020s during a period of back-to-back novel infectious disease outbreaks - Zika virus and COVID-19. We use Brazilian Ministry of Health and Association of Civil Registrar data from 2011-2021 to measure general fertility rates at the national and state levels. We also used seasonal ARIMA model to forecast fertility rates by month and state in 2021 and compared these forecasts with observed fertility rates. We find that fertility rates were steady over 2011-2015 with no statistically significant variation, followed by a sharp decline during the Zika outbreak in 2016 followed by a return to pre-Zika levels after the end of the epidemic. Furthermore, to evaluate the effect of the COVID-19 pandemic, we make comparisons with observed and forecast rates from 2020-2021, showing that declines were generally larger for observed than for forecast rates, yet statistically insignificant. We argue that the resurgence of the COVID-19 pandemic in 2021 might lead to further declines, as women might have not had enough time to adjust rebound from either the effects of the Zika epidemic. We also discuss the importance of timely availability of live births data during a public health crisis with immediate consequences for fertility rates.