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Ning N, Tan X, Li Y, Tang J, Lommel L, Sun M. Changes in fertility intention among married Chinese couples with two children during COVID-19: a cross-sectional study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024; 50:185-193. [PMID: 38503472 DOI: 10.1136/bmjsrh-2022-201759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/12/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND A three-child policy was implemented in China to stimulate a rise in fertility levels and coincided with the COVID-19 pandemic. Data suggested that COVID-19 has a negative impact on fertility intention. AIM To describe married couples' changes in intention to have a third child during the COVID-19 pandemic and determine factors associated with altered intentions. METHODS An online survey was conducted in October 2021, including sociodemographic characteristics, change of intention to have a third child after the COVID-19 pandemic outbreak, reasons for increased or decreased intention, and the Fertility Intention Scale (FIS). Bivariate and multivariable logistic regression were used to test the potential factors associated with changes in intention. RESULTS A total of 1308 participants provided responses. Following the COVID-19 outbreak, 35.8% of participants decreased their third-child intention, while 2.8% of participants increased their third-child intention. Males (aOR 1.90, 95% CI 1.42 to 2.54), youngsters (aOR 1.77, 95% CI 1.08 to 2.93) and those living in Estern China (aOR 2.12, 95% CI 1.13 to 3.98) were more likely to decrease their third-child intention. Perceived risk (aOR 1.07, 95% CI 1.03 to 1.10) and policy support (aOR 1.06, 95% CI 1.03 to 1.09) as measured on the FIS decreased couples' intention to have a third child. Social support (aOR 0.94, 95% CI 0.91 to 0.98) as measured on the scale protected participants from decreased intention. CONCLUSIONS During severe public health emergencies, strong prevention and control policies, together with enhancing support from partners and healthcare professionals for women, are necessary to improve intentions to give birth.
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Affiliation(s)
- Ni Ning
- Graduate School of Innovation and Practice for Smart Society, Hiroshima University, Hiroshima, Japan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiangmin Tan
- School of rural health, Monash University, Melbourne, Victoria, Australia
| | - Ying Li
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Jingfei Tang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Lisa Lommel
- School of Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Mei Sun
- School of Nursing, Xinjiang Medical University, Urumqi, China
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2
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Tam MW, Davis VH, Ahluwalia M, Lee RS, Ross LE. Impact of COVID-19 on access to and delivery of sexual and reproductive healthcare services in countries with universal healthcare systems: A systematic review. PLoS One 2024; 19:e0294744. [PMID: 38394146 PMCID: PMC10889625 DOI: 10.1371/journal.pone.0294744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/01/2023] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES The COVID-19 pandemic has caused unforeseen impacts on sexual and reproductive healthcare (SRH) services worldwide, and the nature and prevalence of these changes have not been extensively synthesized. We sought to synthesise reported outcomes on the impact of COVID-19 on SRH access and delivery in comparable countries with universal healthcare systems. METHODS Following PRISMA guidelines, we searched MEDLINE, Embase, PsycInfo, and CINAHL from January 1st, 2020 to June 6th, 2023. Original research was eligible for inclusion if the study reported on COVID-19 and SRH access and/or delivery. Twenty-eight OECD countries with comparable economies and universal healthcare systems were included. We extracted study characteristics, participant characteristics, study design, and outcome variables. The methodological quality of each article was assessed using the Quality Assessment with Diverse Studies (QuADS) tool. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed for reporting the results. This study was registered on PROSPERO (#CRD42021245596). SYNTHESIS Eighty-two studies met inclusion criteria. Findings were qualitatively synthesised into the domains of: antepartum care, intrapartum care, postpartum care, assisted reproductive technologies, abortion access, gynaecological care, sexual health services, and HIV care. Research was concentrated in relatively few countries. Access and delivery were negatively impacted by a variety of factors, including service disruptions, unclear communication regarding policy decisions, decreased timeliness of care, and fear of COVID-19 exposure. Across outpatient services, providers favoured models of care that avoided in-person appointments. Hospitals prioritized models of care that reduced time and number of people in hospital and aerosol-generating environments. CONCLUSIONS Overall, studies demonstrated reduced access and delivery across most domains of SRH services during COVID-19. Variations in service restrictions and accommodations were heterogeneous within countries and between institutions. Future work should examine long-term impacts of COVID-19, underserved populations, and underrepresented countries.
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Affiliation(s)
- Michelle W. Tam
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Victoria H. Davis
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Monish Ahluwalia
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- University of Toronto Faculty of Medicine, 1 King’s College Circle, Toronto, ON, Canada
| | - Rachel S. Lee
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Lori E. Ross
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
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Roland N, Drouin J, Desplas D, Duranteau L, Cuenot F, Dray-Spira R, Weill A, Zureik M. Impact of coronavirus disease 2019 on contraception use in France. Therapie 2023; 78:593-603. [PMID: 36732137 PMCID: PMC9851715 DOI: 10.1016/j.therap.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 01/21/2023]
Abstract
To limit the spread of the coronavirus disease 2019 (COVID 19), sanitary restrictions have been established since March 2020 in France. These restrictions and the waves of contamination may have had consequences on the use of health products in general, and on the use of contraceptives in particular. We aimed to assess the impact of COVID 19 pandemic from March 16th 2020 to April 30th 2021 in France on reimbursed contraceptives. We analyzed data from the French national health insurance database (SNDS) by extracting all oral contraception (OC), emergency contraception (EC), levonorgestrel-intrauterine system (LNG-IUS), copper-intrauterine device (C-IUD) and contraceptive implant dispensations in 2018, 2019, 2020 and to April 30th 2021. We computed the expected use of contraceptives in 2020 and 2021 without pandemic and its associated sanitary restrictions, by taking the annual trend into account. We assessed the evolution of dispensations by type of contraceptive and by age-groups (≤25 years old, between 25 and 35 and >35 years old) between observed and expected dispensations. After 15 months of pandemic, a decrease of all reimbursed contraceptives dispensations had been estimated, compared with what was expected: -2.0% for OC, -5.0% for EC, -9.5% for LNG-IUS, -8.6% for C-IUD, -16.4% for implant. Women under 25 years old were the most impacted by the decrease. This national study showed that the impact of the COVID 19 crisis was global on all reimbursed contraceptives, with different levels of impact depending on the type of contraceptive, the age-group and the severity of the restriction. OC dispensing decreased marginally compared with expectations. The decrease in long-acting contraceptives dispensing was more pronounced, especially for the implant. These results call for continued monitoring of contraceptive use over the long term and for prioritizing access to sexual health services during crises, especially among the youngest women who were most affected in this study.
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Affiliation(s)
- Noémie Roland
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 93285 Saint-Denis cedex, France; University of Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Anti-infective Evasion and Pharmacoepidemiology, CESP (Center for Research in Epidemiology and Population Health), 78180 Montigny le Bretonneux, France.
| | - Jérôme Drouin
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 93285 Saint-Denis cedex, France
| | - David Desplas
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 93285 Saint-Denis cedex, France
| | - Lise Duranteau
- Adolescent and Young Adult Gynaecology Unit and Reference Center for Rare, Diseases of Genital Development, AP.HP University of Paris Saclay, Bicêtre Hospital, 94270 Le Kremlin Bicêtre, France
| | - François Cuenot
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 93285 Saint-Denis cedex, France
| | - Rosemary Dray-Spira
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 93285 Saint-Denis cedex, France
| | - Alain Weill
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 93285 Saint-Denis cedex, France
| | - Mahmoud Zureik
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 93285 Saint-Denis cedex, France; University of Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Anti-infective Evasion and Pharmacoepidemiology, CESP (Center for Research in Epidemiology and Population Health), 78180 Montigny le Bretonneux, France
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Meng T, Zhang Y, Lv J, Zhu C, Lan L, Zhang T. Effect of the COVID-19 pandemic on women's fertility intentions and its policy implications for China and the rest of the world: a perspective essay. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2023; 68:87-100. [PMID: 37309161 DOI: 10.1080/19485565.2023.2221842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemic and its social, economic, and health implications have generally reduced women's fertility intentions in different countries. In this article, we aimed to review studies of the impact of COVID-19 infection on women's fertility intentions and interventions to provide a theoretical basis and practical benchmark for the development of effective intervention strategies in China, which lifted its zero COVID system in early December 2022.
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Affiliation(s)
- Tiantian Meng
- Huzhou Key Laboratory of Precise Prevention and Control of Major Chronic Diseases, Huzhou University, Huzhou, Zhejiang, P.R. China
| | - Yongmei Zhang
- Huzhou Key Laboratory of Precise Prevention and Control of Major Chronic Diseases, Huzhou University, Huzhou, Zhejiang, P.R. China
| | - Jiayu Lv
- Huzhou Key Laboratory of Precise Prevention and Control of Major Chronic Diseases, Huzhou University, Huzhou, Zhejiang, P.R. China
| | - Chunle Zhu
- Huzhou Key Laboratory of Precise Prevention and Control of Major Chronic Diseases, Huzhou University, Huzhou, Zhejiang, P.R. China
| | - Lan Lan
- Huzhou Key Laboratory of Precise Prevention and Control of Major Chronic Diseases, Huzhou University, Huzhou, Zhejiang, P.R. China
| | - Ting Zhang
- Huzhou Key Laboratory of Precise Prevention and Control of Major Chronic Diseases, Huzhou University, Huzhou, Zhejiang, P.R. China
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Jacapenga RR, Surita F, Bahamondes L, Juliato CRT. Acceptance rate of post-placental plac ement of intrauterine devices during the SARS-CoV-2 (COVID-19) pandemic. EUR J CONTRACEP REPR 2023; 28:92-96. [PMID: 36803168 DOI: 10.1080/13625187.2023.2173004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To evaluate the acceptance rate of post-placental intrauterine device (PPIUD) placement during the SARS-CoV-2 (COVID-19) pandemic and to to assess factors associated with PPIUD acceptance. METHODS A cross-sectional study was conducted between August 2020 and August 2021. PPIUDs were offered to women scheduled for caesarean delivery or admitted in labour at the Women's Hospital of the University of Campinas. The study compared women according to whether they accepted or did not accept the IUD placement. The factors associated with PPIUD acceptance were analysed through bivariate and multiple logistic regression analyses. RESULTS We enrolled 299 women (15.9% of the deliveries that occurred during study period), aged 26.8 ± 6.5 years; 41.8% were White, almost one third were primiparous, and 155/299 (51.8%) had a vaginal delivery. The PPIUD acceptance rate was 65.6%. The principal reason for refusal was the desire for another contraceptive (41.8%). Women with the highest likelihood of accepting a PPIUD were younger (<30 years old has 1.7 more likely or 74% greater), those without a partner (3.4 times more likely) and those after vaginal delivery (1.7 times more likely or 69% greater). CONCLUSION The COVID-19 does not affected the PPIUD placement. PPIUD is a viable alternative during crisis in which women has difficult to access health services. Younger women, those without a partner and after vaginal delivery were more likely to accept a PPIUD during the COVID-19 pandemic.
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Affiliation(s)
- Rodolfo R Jacapenga
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) Faculty of Medical Sciences, Campinas, Brazil
| | - Fernanda Surita
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) Faculty of Medical Sciences, Campinas, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) Faculty of Medical Sciences, Campinas, Brazil
| | - Cássia R T Juliato
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) Faculty of Medical Sciences, Campinas, Brazil
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D’Arcy S, Cao C, Ahn S, Allan V, Ahmadvand A. Trends of intrauterine device insertion and 'Googling' about intrauterine devices before and during the COVID-19 pandemic in Australia. Digit Health 2022; 8:20552076221145799. [PMID: 36583085 PMCID: PMC9793017 DOI: 10.1177/20552076221145799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Objective The COVID-19 pandemic significantly disrupted access to primary care in Australia. This could have negatively impacted reproductive health services rates such as intrauterine device insertion rates, and interest in seeking information about intrauterine devices by searching on Google. We aimed to assess the trends of, and the association between, the actual Medicare service utilization rates for intrauterine device insertion and searching about intrauterine devices on Google, before and during the COVID-19 pandemic. Methods We conducted systematic analyses of secondary data from June 2017 to May 2022, using Medicare and Google Trends data sources. We visualized the rates of intrauterine device insertion, plus Google's search volumes about 'Intrauterine device' and 'Progestin IUDs' as topics. Then, we assessed the correlation between intrauterine device insertion rates and Google search, using Spearman correlation. Results The average yearly rates of intrauterine device insertion increased noticeably from 25.1-26.3 in 2018-2019 to 29.3-31.2 per 100,000 population in 2020-2021 (12-18% increase). The highest monthly intrauterine device insertion rate nationally (37 per 100,000 population) was seen in March 2021. By June 2020, search term use for the two intrauterine device-related topics returned to much higher levels (50% increase for 'Progestin IUDs', and 54% for 'Intrauterine device', respectively). A moderately strong correlation was seen between actual intrauterine device insertion rates and search on Google about intrauterine devices (Spearman rho = 0.61, p < 0.000). Conclusion We demonstrated a moderately strong correlation between trends of intrauterine device insertion rates and search on Google about intrauterine devices, before and during the COVID-19 pandemic in Australia. Googling about intrauterine devices could, therefore, be a useful indicator to gauge future interest in actual intrauterine device insertion for months thereafter.
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Affiliation(s)
| | | | | | | | - Alireza Ahmadvand
- Alireza Ahmadvand, Associate Professor in
Primary Care (Academic Title Holder), School of Medicine and Dentistry, Griffith
University, Gold Coast, Parklands Drive, Southport, QLD 4222, Australia.
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Christian CS, Rossouw L. Scoping review of the impact of coronavirus disease 2019 on unplanned pregnancy. Afr J Prim Health Care Fam Med 2022; 14:e1-e8. [PMID: 36546497 PMCID: PMC9772756 DOI: 10.4102/phcfm.v14i1.3601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/09/2022] [Accepted: 10/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Increased pressure on the healthcare system because of coronavirus disease 2019 (COVID-19) along with national lockdown policies had consequences on the sexual and reproductive health of women. While the pandemic has resulted in changes in pregnancy intentions, child-bearing and fertility, the direction of this relationship is unclear and is likely to be impacted by each country's socio-economic status and stage of fertility transition. Understanding the fertility trajectory and the pandemic is important in understanding population structures and ageing, which have consequences for health policies, budgeting and economic activity. AIM This study aimed to conduct a scoping review of the impact of COVID-19 on unplanned pregnancy. METHODS A rapid review of available literature using Google Scholar, PubMed and Medical Literature Analysis and Retrieval System Online (MEDLINE), SocINDEX, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete and Academic Search Ultimate. Articles in English from 2020 to 2021 were included. RESULTS Fifteen articles were included. These were mostly cross-sectional, primary data-collection surveys exploring the relationship between COVID-19 and child-bearing intentions. CONCLUSION Access to contraceptives, socio-economic status and uncertainty about the health impact of COVID-19 on pregnancy were major themes that emerged when considering child-bearing intentions. Evidence of changes in the number of unplanned pregnancies and abortions was not insignificant but should be explored further. Although the studies covered a range of countries, more studies are needed focusing on low- and middle-income countries where the socio-economic impact of child-bearing intention is greater. There is a need for causal analysis using country-level data and for longer studies using more robust methodologies. The pandemic will continue to influence birth rates.Contribution: This article revealed gaps in the current literature on the measurement of the quantitative and causal impact of the COVID-19 pandemic on fertility and child-bearing. Findings from our study may assist in setting the trajectory for future research.
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Affiliation(s)
- Carmen S. Christian
- Department of Economics, Faculty of Economic and Management Sciences, University of the Western Cape, Bellville, South Africa
| | - Laura Rossouw
- School of Economics and Finance, Faculty of Commerce, Law and Management, University of the Witwatersrand, Johannesburg, South Africa
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VanBenschoten H, Kuganantham H, Larsson EC, Endler M, Thorson A, Gemzell-Danielsson K, Hanson C, Ganatra B, Ali M, Cleeve A. Impact of the COVID-19 pandemic on access to and utilisation of services for sexual and reproductive health: a scoping review. BMJ Glob Health 2022; 7:bmjgh-2022-009594. [PMID: 36202429 PMCID: PMC9539651 DOI: 10.1136/bmjgh-2022-009594] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/13/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction The COVID-19 pandemic has negatively impacted health systems globally and widened preexisting disparities. We conducted a scoping review on the impact of the COVID-19 pandemic on women and girls’ access to and utilisation of sexual and reproductive health (SRH) services for contraception, abortion, gender-based and intimate partner violence (GBV/IPV) and sexually transmitted infections (STIs). Methods We systematically searched peer reviewed literature and quantitative reports, published between December 2019 and July 2021, focused on women and girls’ (15–49 years old) access to and utilisation of selected SRH services during the COVID-19 pandemic. Included studies were grouped based on setting, SRH service area, study design, population and reported impact. Qualitative data were coded, organised thematically and grouped by major findings. Results We included 83 of 3067 identified studies and found that access to contraception, in-person safe abortion services, in-person services for GBV/IPV and STI/HIV testing, prevention and treatment decreased. The geographical distribution of this body of research was uneven and significantly less representative of countries where COVID-19 restrictions were very strict. Access was limited by demand and supply side barriers including transportation disruptions, financial hardships, limited resources and legal restrictions. Few studies focused on marginalised groups with distinct SRH needs. Conclusion Reports indicated negative impacts on access to and utilisation of SRH services globally, especially for marginalised populations during the pandemic. Our findings call for strengthening of health systems preparedness and resilience to safeguard global access to essential SRH services in ongoing and future emergencies.
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Affiliation(s)
- Hannah VanBenschoten
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | | | - Elin C Larsson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden,WHO Collaborating Center for Human Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Margit Endler
- Department of Women and Children’s Health, Karolinska Institutet, Stockholm, Sweden,Department of Obsetrics and Gynecology, Stockholm South General Hospital, Stockholm, Sweden
| | - Anna Thorson
- Department of Sexual and Reproductive Health and Research, WHO, Geneve, Switzerland,Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden,WHO Collaborating Center for Human Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden,Department of Disease Control, London School of Hygiene & Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Bela Ganatra
- Department of Sexual and Reproductive Health and Research, WHO, Geneve, Switzerland
| | - Moazzam Ali
- Department of Sexual and Reproductive Health and Research, WHO, Geneve, Switzerland
| | - Amanda Cleeve
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden,Department of Obsetrics and Gynecology, Stockholm South General Hospital, Stockholm, Sweden
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Stifani BM, Madden T, Micks E, Moayedi G, Tarleton J, Benson LS. Society of Family Planning Clinical Recommendations: Contraceptive Care in the Context of Pandemic Response. Contraception 2022; 113:1-12. [PMID: 35594989 PMCID: PMC9113767 DOI: 10.1016/j.contraception.2022.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 12/16/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has posed a burden to healthcare systems around the world and has changed the way people access health services, including contraception. This document sets forth guidance from the Society of Family Planning for providing contraceptive care in the context of the COVID-19 pandemic, including when access to healthcare is restricted due to pandemic response. It also outlines the role of telehealth for providing contraceptive care beyond the pandemic. Clinicians can use synchronous telemedicine visits and other forms of telehealth to provide many aspects of contraceptive care. Both audio-video and audio-only visits are acceptable forms of telemedicine. Access to permanent contraception should be maintained, especially in the postpartum period. Combined hormonal contraceptive (CHC) users who have asymptomatic or mild COVID-19 infection may continue their contraceptive method, while those admitted to the hospital with severe infection should suspend CHC use until they are clinically recovered. CHC users who take Paxlovid for mild-moderate COVID-19 infection can consider a back-up contraceptive method for the duration of therapy, but clinically relevant drug interactions are unlikely. Future research should examine contraceptive outcomes in people who receive care via telemedicine; and access to telemedicine among historically excluded populations such as adolescents, people of color, people of low socioeconomic status, disabled people, or people who do not speak English as a primary language.
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Affiliation(s)
- Bianca M. Stifani
- New York Medical College, Valhalla, NY, USA,Corresponding Author: Bianca M. Stifani, 19 Bradhurst Ave Suite 2700S, Hawthorne, NY, USA
| | - Tessa Madden
- Washington University School of Medicine, St Louis, MO, USA
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10
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Akinyemi JO, Dipeolu OI, Adebayo AM, Gbadebo BM, Ajuwon GA, Olowolafe TA, Adewoyin Y, Odimegwu CO. Social consequences of COVID-19 on fertility preference consistency and contraceptive use among Nigerian women: insights from population-based data. Contracept Reprod Med 2022; 7:14. [PMID: 35915478 PMCID: PMC9343223 DOI: 10.1186/s40834-022-00181-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emerging evidence from high income countries showed that the COVID-19 pandemic has had negative effects on population and reproductive health behaviour. This study provides a sub-Saharan Africa perspective by documenting the social consequences of COVID-19 and its relationship to fertility preference stability and modern contraceptive use in Nigeria. METHOD We analysed panel data collected by Performance Monitoring for Action in Nigeria. Baseline and Follow-up surveys were conducted before the COVID-19 outbreak (November 2019-February 2020) and during the lockdown respectively (May-July 2020). Analysis was restricted to married non-pregnant women during follow-up (n = 774). Descriptive statistics and generalized linear models were employed to explore the relationship between selected social consequences of COVID-19 and fertility preferences stability (between baseline and follow-up) as well as modern contraceptives use. RESULTS Reported social consequences of the pandemic lockdown include total loss of household income (31.3%), food insecurity (16.5%), and greater economic reliance on partner (43.0%). Sixty-eight women (8.8%) changed their minds about pregnancy and this was associated with age groups, higher wealth quintile (AOR = 0.38, CI: 0.15-0.97) and household food insecurity (AOR = 2.72, CI: 1.23-5.99). Fertility preference was inconsistent among 26.1%. Women aged 30-34 years (AOR = 4.46, CI:1.29-15.39) were more likely of inconsistent fertility preference compared to 15-24 years. The likelihood was also higher among women with three children compared to those with only one child (AOR = 3.88, CI: 1.36-11.08). During follow-up survey, 59.4% reported they would feel unhappy if pregnant. This was more common among women with tertiary education (AOR = 2.99, CI: 1.41-6.33). The odds increased with parity. The prevalence of modern contraceptive use was 32.8%. Women aged 45-49 years (AOR = 0.24, CI: 0.10-0.56) were less likely to use modern contraceptives than those aged 15-24 years. In contrast, the odds of contraceptive use were significantly higher among those with three (AOR = 1.82, CI: 1.03-3.20), four (AOR = 2.45, CI: 1.36-4.39) and at least five (AOR = 2.89, CI: 1.25-6.74) children. Unhappy disposition towards pregnancy (AOR = 2.48, CI: 1.724-3.58) was also a significant predictor of modern contraceptive use. CONCLUSION Some social consequences of COVID-19 affected pregnancy intention and stability of fertility preference but showed no independent association with modern contraceptive use.
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Affiliation(s)
- Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria. .,Infectious Diseases Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria. .,Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Oluwafemi I Dipeolu
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayodeji M Adebayo
- Department of Community Medicine, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Babatunde M Gbadebo
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Grace A Ajuwon
- E.Latunde Odeku Medical Library, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Tubosun A Olowolafe
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Yemi Adewoyin
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Geography, University of Nigeria, Nsukka, Nigeria
| | - Clifford O Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Rocca CH, Parra M, Muñoz I, Foster DG, Boscardin WJ, Ralph LJ. Comparison of Pregnancy Preferences Preceding vs Year 1 of the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2220093. [PMID: 35788671 PMCID: PMC9257576 DOI: 10.1001/jamanetworkopen.2022.20093] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/17/2022] [Indexed: 12/05/2022] Open
Abstract
Importance Understanding how the COVID-19 pandemic affected people's desire to avoid pregnancy is essential for interpreting the pandemic's associations with access to reproductive health care and reproductive autonomy. Early research is largely cross-sectional and relies on people's own evaluations of how their desires changed. Objective To investigate longitudinal changes in pregnancy desires during the year before and the first year of the COVID-19 pandemic. Design, Setting, and Participants In this cohort study, participants reported their pregnancy preferences at baseline and quarterly for up to 18 months between March 2019 and March 2021. An interrupted time series analysis with mixed-effects segmented linear regression was used to examine population-averaged time trends. People were recruited from 7 primary and reproductive health care facilities in Arizona, New Mexico, and Texas. Participants were sexually active, pregnancy-capable people aged 15 to 34 years who were not pregnant or sterilized. Data analysis was performed from September 2021 to January 2022. Exposures Continuous time, with knots at the onset of the first (July 1, 2020, summer surge) and second (November 1, 2020, fall surge) COVID-19 cases surges in the Southwest. Main Outcomes and Measures Preferences around potential pregnancy in the next 3 months, measured using the validated Desire to Avoid Pregnancy (DAP) scale (range, 0-4, with 4 indicating a higher desire to avoid pregnancy). Results The 627 participants in the analytical sample had a mean (SD) age of 24.9 (4.9) years; 320 (51.0%) identified as Latinx and 180 (28.7%) as White. Over the year before the first case surge in the US Southwest in summer 2020, population-averaged DAP scores decreased steadily over time (-0.06 point per quarter; 95% CI, -0.07 to -0.04 point per quarter; P < .001). During the summer 2020 surge, DAP scores stopped declining (0.05 point per quarter; 95% CI, -0.03 to 0.13 point per quarter; change in slope, P < .001). During the fall 2020 surge, however, DAP scores declined again at -0.11 point per quarter (95% CI, -0.26 to 0.04 point per quarter; change in slope, P = .10). Participants aged 15 to 24 years and those who were nulliparous and primiparous experienced greater declines in DAP score before the summer surge, and greater reversals of decline between summer and fall 2020, than did those who were aged 25 to 34 years and multiparous. Conclusions and Relevance These findings suggest that the COVID-19 pandemic onset was associated with the stalling of a prior trend toward greater desire for pregnancy over time, particularly for people earlier in their reproductive lives.
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Affiliation(s)
- Corinne H. Rocca
- Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health, School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland
| | - Miriam Parra
- Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health, School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland
- School of Nursing, University of California, San Francisco
| | - Isabel Muñoz
- Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health, School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland
- School of Public Health, Division of Epidemiology, University of California, Berkeley
| | - Diana G. Foster
- Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health, School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland
| | - W. John Boscardin
- School of Medicine, Department of Medicine, University of California, San Francisco
- School of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Lauren J. Ralph
- Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health, School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland
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Experiences of access and use of contraceptive care during COVID-19 lockdown in the UK: a web-based survey. BJGP Open 2022; 6:BJGPO.2021.0218. [PMID: 35487583 DOI: 10.3399/bjgpo.2021.0218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/15/2022] [Accepted: 04/04/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The first wave of lockdown measures to control the covid-19 pandemic in the United Kingdom (UK) resulted in suspension of "non-essential" services including contraception. AIM To examine women's perceptions and experiences of contraceptive care in the UK during the first lockdown. DESIGN & SETTING Cross-sectional survey during lockdown period from March to June 2020. METHOD We designed an online questionnaire asking women aged 16-54 their experiences of contraceptive care during lockdown. Questions were based on Maxwell's evaluation framework on access, acceptability, relevance, and equity. It was promoted on social media from 27th May to ninth June 2020. We conducted descriptive analysis of quantitative data and thematic analysis of free text data. RESULTS 214 responses were analysed. General practice was the source of contraception for 43% and 52% of respondents before and during the lockdown respectively. 55% (118/214) of respondents including regular and new users were uncertain where or how to get contraception during the pandemic. Respondents reported reduced access to contraception during lockdown, some thought sexual health clinics and general practices were closed.Remote consultations and electronic prescriptions facilitated contraceptive access for some respondents. Long-acting reversible contraception (LARC) was unavailable in some areas due to restrictions, alternatives were not acceptable to those who used methods for non-contraceptive benefits to treat medical conditions e.g., menorrhagia. CONCLUSIONS Our study highlighted the need for better information and signposting for contraception during lockdown. Contraception including LARC should be reframed as an essential service with robust signposting for pandemic planning and beyond.
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Coombe J, Bittleston H, Hocking JS. Access to period products during the first nation-wide lockdown in Australia: Results from an online survey. Women Health 2022; 62:287-292. [DOI: 10.1080/03630242.2022.2057631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jacqueline Coombe
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Helen Bittleston
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Jane S. Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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Bourchier L, Bittleston H, Hocking J, Coombe J. Changes to pubic hair removal practices during COVID-19 restrictions and impact on sexual intimacy. CULTURE, HEALTH & SEXUALITY 2022; 25:505-520. [PMID: 35369849 DOI: 10.1080/13691058.2022.2056246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pubic hair grooming (hair removal) has been linked to body image and sexual behaviour and, given the impacts of COVID-19 restrictions on access to sexual partners and beauty salons, we explored these associations. Data derive from a cross-sectional online survey. Participants were aged 18 years or over and in Australia. All genders were included. We explored factors associated with changes to hair removal using logistic regression and analysed free-text responses using content analysis. Of 256 participants, 89 (34.8%) had changed their grooming practices. Multivariable analysis found that female participants had 4.5 times increased odds of changed grooming (95%CI 1.8, 11.0; p = 0.001) compared with males. Individuals who reported 'more' or 'less' oral sex compared with the previous year were more likely to report increased odds of changed grooming (AOR 3.2; 95%CI: 1.4, 7.7; p = 0.009 and AOR: 3.3; 95%CI:1.6, 6.7; p = 0.001, respectively). Most who changed their grooming practices said it had reduced, attributing this to lack of partners, inability to access beauticians, and the mental health effects of the pandemic. For most, this change had no impact on sexual behaviour or body image; however, some spoke of reduced sexual desire and willingness to receive oral sex. Partner expectations influenced whether reduced grooming had negative consequences, and women were more affected than men, highlighting a gendered impact.
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Affiliation(s)
- Louise Bourchier
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Helen Bittleston
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jane Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jacqueline Coombe
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Roland N, Drouin J, Desplas D, Duranteau L, Cuenot F, Dray-Spira R, Weill A, Zureik M. Impact of Coronavirus Disease 2019 (COVID-19) On Contraception Use in 2020 and up until the end of April 2021 in France. Contraception 2021; 108:50-55. [PMID: 34971603 PMCID: PMC8714238 DOI: 10.1016/j.contraception.2021.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022]
Abstract
Objectives To assess the impact of the COVID-19 pandemic on the use of reimbursed contraceptives in France after 15 months of the pandemic, according to age-group and updating previous data only pertaining to the first lockdown (2 months). Study design We conducted a national register-based study by extracting all reimbursements of oral contraceptives (OC), emergency contraception (EC), intrauterine devices (IUD), and implants from the French National Health Insurance database (SNDS), which includes and covers 99.5% of the French population, in 2018, 2019, 2020 and from January 1, 2021 to April30, 2021. We calculated the expected use of contraceptives in 2020 and 2021 in the absence of the pandemic, based on 2018 and 2019 usage and taking annual trends into account. We assessed the difference between observed and expected dispensing rates by contraceptive type and by age-group (≤18 years old, 18< age ≤25, 25< age ≤35, >35). Results Dispensing of all contraceptives decreased compared to expect dispensing numbers: −2.0% for OC, −5.3% for EC, −9.5% for LNG-IUS, −8.6% for C-IUD, and −16.4% for implant. This decrease in the dispensing of contraceptives was observed in all age-groups, but mainly concerned women under the age of 18 years (−22% for OC, −10% for EC, −37.2% for LNG-IUS, −36.4% for C-IUD, −26.4% for implant) and those aged 18 to 25 (−5.1% for OC, −11.9% for EC, −18.1% for LNG-IUS, −15.9% for C-IUD, −17.6% for implants). Conclusions Our study showed that the dispensing of contraceptives in France was markedly impacted by the COVID-19 pandemic. Prescriptions for long-acting contraceptive use and women under the age of 25 years were the most substantially impacted. Ensuring access to contraceptive methods during health emergencies must be a public health policy priority. Implications The COVID-19 pandemic strongly impacted the dispensing of contraceptives in France with varying degrees of decreased dispensing according to the type of contraceptive, the age-group and the level of pandemic-related restrictions. The impact of these restrictions on unintended pregnancy at the population level remains undetermined.
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Affiliation(s)
- Noémie Roland
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France; University of Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Anti-infective Evasion and Pharmacoepidemiology, CESP (Center for Research in Epidemiology and Population Health), 2 Avenue de la Source de la Bièvre 78180, Montigny le Bretonneux, France.
| | - Jérôme Drouin
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France
| | - David Desplas
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France
| | - Lise Duranteau
- Adolescent and Young Adult Gynaecology Unit and Reference Center for Rare, Diseases of Genital Development, AP.HP University of Paris Saclay, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - François Cuenot
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France
| | - Rosemary Dray-Spira
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France
| | - Alain Weill
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France
| | - Mahmoud Zureik
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety, and French National Health Insurance), 143/147 Boulevard Anatole France, 93285 Saint-Denis Cedex, France; University of Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Anti-infective Evasion and Pharmacoepidemiology, CESP (Center for Research in Epidemiology and Population Health), 2 Avenue de la Source de la Bièvre 78180, Montigny le Bretonneux, France
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Mukherjee TI, Khan AG, Dasgupta A, Samari G. Reproductive justice in the time of COVID-19: a systematic review of the indirect impacts of COVID-19 on sexual and reproductive health. Reprod Health 2021; 18:252. [PMID: 34930318 PMCID: PMC8686348 DOI: 10.1186/s12978-021-01286-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 11/06/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Despite gendered dimensions of COVID-19 becoming increasingly apparent, the impact of COVID-19 and other respiratory epidemics on women and girls' sexual and reproductive health (SRH) have yet to be synthesized. This review uses a reproductive justice framework to systematically review empirical evidence of the indirect impacts of respiratory epidemics on SRH. METHODS We searched MEDLINE and CINAHL for original, peer-reviewed articles related to respiratory epidemics and women and girls' SRH through May 31, 2021. Studies focusing on various SRH outcomes were included, however those exclusively examining pregnancy, perinatal-related outcomes, and gender-based violence were excluded due to previously published systematic reviews on these topics. The review consisted of title and abstract screening, full-text screening, and data abstraction. RESULTS Twenty-four studies met all eligibility criteria. These studies emphasized that COVID-19 resulted in service disruptions that effected access to abortion, contraceptives, HIV/STI testing, and changes in sexual behaviors, menstruation, and pregnancy intentions. CONCLUSIONS These findings highlight the need to enact policies that ensure equitable, timely access to quality SRH services for women and girls, despite quarantine and distancing policies. Research gaps include understanding how COVID-19 disruptions in SRH service provision, access and/or utilization have impacted underserved populations and those with intersectional identities, who faced SRH inequities notwithstanding an epidemic. More robust research is also needed to understand the indirect impact of COVID-19 and epidemic control measures on a wider range of SRH outcomes (e.g., menstrual disorders, fertility services, gynecologic oncology) in the long-term.
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Affiliation(s)
- Trena I Mukherjee
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Angubeen G Khan
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Anindita Dasgupta
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA
| | - Goleen Samari
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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Mazza D. Increasing access to women's sexual and reproductive health services: telehealth is only the start. Med J Aust 2021; 215:352-353. [PMID: 34510470 DOI: 10.5694/mja2.51258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022]
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