Contraception and reproductive planning during the COVID-19 pandemic

Estrogen-based hormonal therapy and the risk of thrombosis in COVID-19 patients

OBJECTIVE

Estrogen-containing contraceptives and hormone replacement therapy are used commonly, however, the risks of venous and arterial thrombosis imparted by such medications during COVID-19 infection or other similar viral infections remain undescribed.

METHODS

To assess the risk of venous and arterial thrombosis in patients receiving oral estrogen-containing therapy (ECT) with COVID-19 as compared to those receiving non-estrogen-based hormonal therapy, we conducted a multicenter cohort study of 991 patients with confirmed COVID-19 infection, 466 receiving estrogen-containing hormonal therapy, and 525 receiving progestin-only or topical therapy.

RESULTS

The use of estrogen-containing therapy was found to significantly increase the risk of venous thromboembolism (VTE) following COVID-19 diagnosis after controlling for age (HR 5.46 [95% CI 1.12-26.7, p = .036]). This risk was highest in patients over age 50, with 8.6% of patients receiving estrogen-containing therapy diagnosed with VTE compared to 0.9% of those receiving non-estrogen-based therapies (p = .026). The risk of arterial thrombosis was not significantly associated with oral estrogen use.

CONCLUSIONS

These results suggest that estrogen-containing therapy is associated with a significantly increased risk of VTE in COVID-19 patients, especially in older individuals. These findings may guide provider counseling and management of patients with COVID-19 on estrogen-containing therapy.

Association between COVID-19 and sexual health: an umbrella review

PURPOSE

We conducted this umbrella review to review the current evidence on the relationship between COVID-19 and sexual health in both men and women.

METHODS

We conducted searches in Pubmed, Embase, and the Cochrane dataset for meta-analyses that met our pre-set inclusion criteria. We included studies with detailed information investigating the link between COVID-19 and sexual health in men/women. We did not limit the language.

RESULTS

The results of the included studies frequently relied on the Female Sexual Function Index to assess sexual health in women. For men, the International Index of Male Function and hospital diagnoses were commonly used to assess sexual health. Currently, there is conflicting evidence regarding the impact of COVID-19 on sexual health. However, since most studies were observational in nature, additional study designs are necessary to draw definitive conclusions across different contexts.

CONCLUSION

Our findings highlight the importance of sexual health among COVID-19 patients and people affected due to COVID-19. Further critical studies should investigate the mechanism underlying the association between COVID-19 and sexual health.

How did regional lockdowns during the COVID-19 pandemic affect recruitment into a large multinational cohort study of intrauterine device users?

OBJECTIVES

To investigate the impact of lockdown policies on the recruitment of an ongoing cohort study.

STUDY DESIGN

We performed descriptive analyses of recruitment, dropout, and baseline characteristics over time. Oxford Stringency Index was used to assess the impact of regional constraints on recruitment.

RESULTS

Drop in recruitment clearly reflected the Stringency Index within the first months of the pandemic. Unexpectedly, drop-out rates declined in 2020/2021. Baseline characteristics were comparable, yet younger women were recruited more frequently during the pandemic.

CONCLUSIONS

There was no strong evidence of recruitment bias due to the pandemic.

IMPLICATIONS

The COVID-19 pandemic is a potential source of bias for ongoing studies and its influence on the study conduct (e.g., recruitment, drop-out) should be thoroughly evaluated to ensure that study results are not biased in this regard. The Oxford's Government Stringency Index can be used to identify pandemic-affected time periods.

COVID-19, relationships, and contraception: Qualitative perspectives from emerging adults during the COVID-19 lockdown in Accra, Ghana

Globally, family planning services were disrupted during the height of the COVID-19 pandemic. Access to these services was a challenge for sexually active urban youth, and this warrants investigation. Using in-depth interview data, we qualitatively explored the effect of the lockdown on the relationship quality and contraception behaviour of emerging adults (19-24 year olds) who were in relationships during a specified lockdown period. Participants were purposively selected from a densely populated urban area in Accra and two public universities in that vicinity. In-depth interviews were also conducted with two family planning providers. Transcripts generated from the interviews were analysed thematically. Twelve of the 23 emerging adults were sexually active during the lockdown and varied in their reports on the stability of their relationships. The sexually inactive had disruptions in their relationships, mainly due to partner absence and a lack of sexual activity. Modern contraceptives, especially male condoms, were used but were obtained prior to the lockdown as confirmed by family planning providers. Traditional and folkloric methods were used by four participants. Participants reported no unintended pregnancies but rare cases of sexually transmitted infections. During the height of the COVID-19 pandemic, sexually active urban youth in Accra navigated the restrictions of lockdown imposition with diverse experiences. Therefore, understanding young adults' unique contraceptive behaviours and practices is essential to providing relevant sexual and reproductive health services to meet their needs. Discussions on the impacts of COVID-19 should be extended to sexual and reproductive health concerns such as access to contraceptives.

The prevalence of sexual dysfunctions in pregnant women and the correlated factors: a systematic review and meta-analysis

BACKGROUND

Sexual functions are negatively affected during pregnancy with the emergence of physical, hormonal, mental, emotional, and behavioral changes; however, there is no cumulative knowledge about the global prevalence of sexual dysfunction (SD) in pregnant women and the correlated factors in SD.

AIM

The study aimed to determine the prevalence of SD among pregnant women and the factors correlated with their SD scores.

METHODS

A systematic review and meta-analysis of studies focusing on SD in pregnant women were conducted in the PubMed, EBSCOhost, Web of Science, Turkish Medline, Scopus, Google Scholar, and Ovid databases by using the following combination of keywords: "pregnant" OR "pregnancy" AND "sexual dysfunction."

OUTCOMES

Nearly 70% of pregnant women were at risk for SD. The age of the pregnant woman, the spouse's age, and the duration of marriage were negatively correlated with the SD score, while the education level was positively correlated with it.

RESULTS

Initially, 5644 studies were identified: 693 studies were evaluated for eligibility and 668 were removed following the exclusion criteria. A total of 25 studies involving 6871 pregnant women were included in the meta-analysis. The pooled SD prevalence in pregnant women was 69.7% (95% CI, 59.9%-77.9%).

CLINICAL IMPLICATIONS

The results of this study can be used in the organization of prenatal care, especially for pregnant women at high risk for SD.

STRENGTHS AND LIMITATIONS

This meta-analysis is the first to reveal the global prevalence of SD and the factors correlated with SD scores in pregnant women. The most important limitation of this study is that it analyzes documents showing pregnant women at risk for SD according to an unconfirmed measurement tool for pregnant women.

CONCLUSION

Most pregnant women experience SD symptoms. More research is needed, specifically on validated tools that assess pregnancy-specific SD symptoms.

Impact of the COVID-19 pandemic on dispensing medicines in the community pharmacy

BACKGROUND

The world has faced an unprecedented challenge since COVID-19 emerged as a pandemic, which has led to quarantine and disruptions in drug services. During the pandemic, drug use habits and availability changed, causing a shift in behaviors and, in turn, medicine misuse. In Iraq, this is a major problem because many medicines can be easily obtained.

OBJECTIVE

The study aims to describe the pattern of dispensing medications during the pandemic and to evaluate the biochemical and pathological consequences.

METHOD

The analytical, observational, cross-sectional study was performed via a compiled questionnaire for 400 random pharmacists, and the analysis and interpretation of the biochemical changes and medical reports.

RESULTS

Results revealed that dispensing of medications since the COVID-19 outbreak has increased by 74%, and the demand for medicines seems higher than required in comparison to the periods before the pandemic, while 60% of the dispensed medicines were taken just in case needed. In addition, the availability of medicines decreased by 61%, and the dispensing of common medicines increased due to the belief in their prophylactic action. Several biochemical abnormalities and pathological consequences were recorded due to the irrational use of medicines, and the highest percentage (12%) was seen in hepatic and liver enzymatic dysfunction and 8% for the endocrine and hormonal abnormalities.

CONCLUSION

It can be concluded that most of the dispensed medicines were not used on a therapeutic or scientific basis during the pandemic.

Trends of intrauterine device insertion and 'Googling' about intrauterine devices before and during the COVID-19 pandemic in Australia

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.

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.

Impact of COVID-19 on the prescription of contraceptives in a city in São Paulo

OBJECTIVE

In the beginning of the pandemic, measures, such as social distancing, lockdown strategies, and restrictions on mobility, as well as the fear of transiting through health facilities, raised concerns about the impact of COVID-19 on women's ability to continue using contraceptives.

METHODS

This is a retrospective cohort study, which evaluated reports of medication distribution spreadsheets in Bauru - SP, from January 2019 to June 2021.

RESULTS

Our study showed that the municipal dispensation of contraceptives in the SUS was markedly impacted by the COVID-19 pandemic, suffering reductions that can impact on an increase in unplanned pregnancy rates. It is possible to note a significant decrease in the distribution of combined oral contraceptives (44.18%), combined injectable contraceptives (47.58% reduction), and medroxyprogesterone acetate (13.98%). This fact may be associated with the reduction in offers of face-to-face consultations in gynecology, due to the social isolation necessary at the time of the pandemic.

CONCLUSION

Ensuring access to contraceptives during health emergencies should be a public health policy priority. Thus, it is essential to draw up strategic plans to encourage full access to reproductive planning services even in times of health emergency, so that the occurrence of unplanned pregnancies can be adequately prevented.

Mental and Sexual Health of Men in Times of COVID-19 Lockdown

Due to the worldwide spread of COVID-19, some restrictions were introduced which could lead to the development of distress and somatic symptoms. This survey aimed to study the mental and sexual health of men during the COVID-19 outbreak. An online questionnaire was conducted to collect data on contact with people suspected of infection/infected with the SARS-CoV-2 virus, use of stimulants, and perceived mental and sexual health during isolation among Polish men. They were also asked to answer the Beck Depression Inventory (BDI) and the International Index of Erectile Function (IIEF-15) questionnaire. In total, 606 men with a mean age of 28.46 ± 9.17 years took part in the survey. Fear of contracting the COVID-19 infection had a negative impact on the mental health of 132 men (21.8%). Fear of the health condition of loved ones caused stress and a depressed mood in 253 men (41.7%), and media reports worsened the mental health of 185 men (30.2%). In the BDI, 71.95% of the respondents did not suffer from depressive symptoms, 17.33% were diagnosed with mild depression, 6.11% with moderate depression, and 4.62% had severe depression. The mean score in the IIEF-15 questionnaire in the erectile function domain was 22.27, orgasm-7.63, desire-8.25, satisfaction-10.17, and general satisfaction-6.84. Depressive symptoms indicated more severe sexual functioning disorders (p < 0.001). Fear, following the media, and loneliness were associated with more severe depressive and sexual disorders (p < 0.001). The libido level (p = 0.002) and frequency of sexual activity (p < 0.001) were also lower during the pandemic than before the lockdown. These data showed that the COVID-19 pandemic had a significant impact on male mental and sexual health.

The COVID-19 pandemic's impact on sexual and reproductive health in Georgia, USA: An exploration of behaviors, contraceptive care, and partner abuse

OBJECTIVE

Assessing access to sexual and reproductive health care during the COVID-19 pandemic, experiences with intimate partner violence (IPV), and exploring sociodemographic disparities STUDY DESIGN: From September 2020 to January 2021, we recruited 436 individuals assigned female at birth (18-49 years.) in Georgia, USA for an online survey. The final convenience sample was n = 423; a response rate could not be calculated. Survey themes included: sociodemographic and financial information, access to contraceptive services/care, IPV, and pregnancy. Respondents who reported a loss of health insurance, difficulty accessing contraception, barriers to medical care, or IPV were characterized as having a negative sexual and reproductive health experience during the pandemic. We explored associations between sociodemographic variables and negative sexual and reproductive health experiences.

RESULTS

Since March 2020, 66/436 (16%) of respondents lost their health insurance, and 45% (89/436) reported income loss. Of our sample, 144/436 people (33%) attempted to access contraception. The pandemic made contraceptive access more difficult for 38/144 (26%) of respondents; however, 106/144 (74%) said it had no effect or positive effect on access. Twenty-one respondents reported IPV (5%). COVID-19 amplified negative views of unplanned pregnancy. Seventy-six people (18%) reported at least 1 negative sexual and reproductive health experience during the pandemic; people in an urban setting and those identifying as homo/bisexual were more likely to report negative experiences (24%, 28% respectively).

CONCLUSION

Urban and sexual minority populations had negative sexual and reproductive health experiences during COVID-19 more than their counterparts. The pandemic has shifted perspectives on family planning, likely due to the diverse impacts of COVID-19, including loss of health insurance and income.

IMPLICATION

Females across Georgia reported varying impacts of the COVID-19's pandemic on their sexual and reproductive health care. These findings could be utilized to propose recommendations for care and intimate partner violence support mechanisms, tailored to urban and sexual minority populations.

Competing health risks associated with the COVID-19 pandemic and early response: A scoping review

BACKGROUND

COVID-19 has rapidly emerged as a global public health threat with infections recorded in nearly every country. Responses to COVID-19 have varied in intensity and breadth, but generally have included domestic and international travel limitations, closure of non-essential businesses, and repurposing of health services. While these interventions have focused on testing, treatment, and mitigation of COVID-19, there have been reports of interruptions to diagnostic, prevention, and treatment services for other public health threats.

OBJECTIVES

We conducted a scoping review to characterize the early impact of COVID-19 on HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition.

METHODS

A scoping literature review was completed using searches of PubMed and preprint servers (medRxiv/bioRxiv) from November 1st, 2019 to October 31st, 2020, using Medical Subject Headings (MeSH) terms related to SARS-CoV-2 or COVID-19 and HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. Empiric studies reporting original data collection or mathematical models were included, and available data synthesized by region. Studies were excluded if they were not written in English.

RESULTS

A total of 1604 published papers and 205 preprints were retrieved in the search. Overall, 8.0% (129/1604) of published studies and 10.2% (21/205) of preprints met the inclusion criteria and were included in this review: 7.3% (68/931) on HIV, 7.1% (24/339) on tuberculosis, 11.6% (26/224) on malaria, 7.8% (19/183) on sexual and reproductive health, and 9.8% (13/132) on malnutrition. Thematic results were similar across competing health risks, with substantial indirect effects of the COVID-19 pandemic and response on diagnostic, prevention, and treatment services for HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition.

DISCUSSION

COVID-19 emerged in the context of existing public health threats that result in millions of deaths every year. Thus, effectively responding to COVID-19 while minimizing the negative impacts of COVID-19 necessitates innovation and integration of existing programs that are often siloed across health systems. Inequities have been a consistent driver of existing health threats; COVID-19 has worsened disparities, reinforcing the need for programs that address structural risks. The data reviewed here suggest that effective strengthening of health systems should include investment and planning focused on ensuring the continuity of care for both rapidly emergent and existing public health threats.

Knowledge, Attitude, and Practices Related to the SARS-CoV-2 Pandemic among Women Seeking Contraceptive Methods

OBJECTIVE

 To determine knowledge, attitude, and preventive (KAP) practices towards the SARS-CoV-2 (COVID-19) pandemic among women in reproductive age seeking to use copper or hormonal intrauterine devices (IUD/LNG-IUS).

METHODS

 We conducted a cross-sectional study in which we applied a questionnaire on 400 women about KAP practices on COVID-19 at the University of Campinas, Campinas, SP, Brazil, from May to August 2020.

RESULTS

 The mean (±SD) age of the women was 30.8 ± 7.9 years, and 72.8% of them reported being pregnant at least once. Most women (95%) had heard or read about COVID-19, and their main sources of information were television (91%) and government websites (53%). However, 53% of the women had doubts about the veracity of the information accessed.

CONCLUSION

 Women without a partner and with > 12 years of schooling had more information about COVID-19 and on its impact on new pregnancy, and those from high socioeconomic status had a higher chance of maintaining physical distance. Safety, effectiveness, comfort, and absence of hormone in the contraceptive method (in the case of TCu380A IUD) were the main reasons for the participants to seek the service during the pandemic, and the possibility to stop menstrual bleeding was the main reason to choose the LNG-IUS.

Telehealth for Contraceptive Services During the COVID-19 Pandemic: Provider Perspectives

Background

Telehealth use rapidly increased during the COVID-19 pandemic, including for contraceptive care (e.g., counseling and method provision). This study explored providers’ experiences with contraceptive care via telehealth.

Methods

We conducted a survey with open-ended responses among contraceptive providers across the United States. The study population included physicians, nurse practitioners, health educators, and other health professionals (n = 546). Data were collected from April 10, 2020, to January 29, 2021. We conducted qualitative content analysis of the open-ended responses.

Results

Providers highlighted the benefits of telehealth, including continuing access to contraceptive services and accommodating patients who faced challenges attending in-person contraceptive visits. Providers at school-based health centers reported telehealth allowed them to reach young people while schools were closed. However, many providers noted a lack of patient awareness about the availability of telehealth services and disparities in access to technology. Providers felt there was less personal connection in virtual contraceptive counseling, noted challenges with confidentiality, and expressed concern about the inability to provide the full range of contraceptive methods through telehealth alone.

Conclusions

The pandemic significantly impacted contraceptive health care delivery. Telehealth has sustained access to contraception in important ways, but has been accompanied by various challenges, including technological access and confidentiality. As hybrid models of care evolve, it is important to assess how telehealth can play a role in providing contraceptive care while addressing its barriers.

Period poverty and mental health in times of covid-19 in France

We investigate the relationship between period poverty and anxiety and depression in women aged from 18 to 50 years in the context of the first French covid19 lockdown. 890 participants completed an online survey. Anxiety was assessed with the General Anxiety Disorder scale, depression with the Major Depression Inventory. 9.6% of participants experienced difficulties accessing period protection during the first lockdown. Among the women experiencing period poverty, 49.4% showed depressive symptoms compared to 28.6% of the women who had not experienced menstrual poverty, 40% showed anxious symptoms (vs 24.1%). The relationships between period poverty, depression and are significant even in adjusted models controlled by sociodemographics variables (depression: AOR = 2.191 [1.372 - 3.499]; anxiety: AOR = 1.793, [1.110 - 2.897]). As clinicians, psychologists or social workers, it seems interesting to go beyond the first symptoms of depression and anxiety and question the patients' access to menstrual health products.

Effects of the pandemic on women's reproductive health protective attitudes: a Turkish sample

OBJECTIVES

This descriptive, cross-sectional study was performed to examine the effects of the COVID-19 pandemic on women's reproductive health protective attitudes.

METHODS

The study sample included 306 women and data were collected through a web-based, online questionnaire. The data were collected using the Personal Information Form, Determination of Married Women's Reproductive Health Protective Attitudes Scale. Descriptive statistics, independent samples t-test, ANOVA test were used to assess the data.

RESULTS

The mean scores for Determination of Married Women's Reproductive Health Protective Attitudes Scale significantly differed in terms of education, employment status, income, health insurance and perceived health status (p < 0.05). A total of 69.3% of women had their first pregnancy at the agerange of 21-34 years, 17.6% of the women had four or more pregnancies, 55.6% of the women gave birth 1-3 times, 13.4% of the women gave birth at home and 57.8% of the women did not use modern family planning methods. A total of 23.2% of women experienced a problem with their reproductive organs during the pandemic, 70.6% of them did not present to a health center for their problems and 74.5% of these women did not present to a health center to avoid the risk of COVID-19 transmission. A total of 40.2% of women used the methods they already know at home to relieve their problems and 16.0% of the women used them edications previously prescribed by their doctors.

CONCLUSION

The pandemic negatively affects there productive health of women. In the COVID-19 pandemic, health policies should be planned in accordance with the continuation of reproductive health and sexual health services.

Effect of the Covid pandemic on progestogen-only and oestrogen-containing contraceptive prescribing in general practice: a retrospective analysis of English prescribing data

OBJECTIVES

This paper looks at how trends in contraceptive prescribing by General Practices in England were affected by the Covid pandemic and lockdown. It compares English prescribing data from May 2014 to May 2021, including the period of 'lockdown', from April 20-June 20.

DESIGN & SETTING

A retrospective analysis of the English Prescribing Dataset which reports monthly on prescribed items from English General Practices was carried out. Data on all forms of prescribed contraceptive methods were extracted using British National Formulary (BNF) codes, and total quantities tabulated by method, then transformed into 'months of contraception provided' by each method.

RESULTS

Prescription of the combined oral contraceptive pill reduced by 22% during the period of lockdown compared to the same three months in 2019. Prescriptions of Progestogen-Only pills remained stable. This continued a trend in oral contraceptive prescribing evident from May14. Prescription of long-acting methods reduced during the period of lockdown, with the greatest reductions in implants (76% reduction from pre-lockdown levels), intra-uterine systems (79% reduction from pre-lockdown levels) and intrauterine devices (76% reduction from pre-lockdown levels). These rates of contraceptive provision recovered quickly after the period of lockdown ended.

CONCLUSIONS

The disruption of face-to-face contraceptive consultations in General Practice during a Covid-19 'lockdown' has resulted in a reduction in oestrogen -containing methods compared to progestogen-only methods, which require less face-to-face monitoring. Implant and intrauterine contraceptive device prescription reduced by three quarters over the first three months of lockdown, but rebounded in the next year.

Effect of the COVID-19 pandemic on contraceptive prescribing in general practice: a retrospective analysis of English prescribing data between 2019 and 2020

OBJECTIVES

This paper looks at how contraceptive prescribing by General Practices in England was affected by the COVID-19pandemic and lockdown. It compares English prescribing data in April - June 2019, the year before COVID19, and April-June 2020, the first three months of 'lockdown'.

DESIGN & SETTING

This paper is based on retrospective analysis of the English Prescribing Dataset which reports monthly on prescribed items from English General Practices. Data on all forms of prescribed contraceptive methods were extracted using BNF codes, and total quantities tabulated by method. To reach the total number of months of contraception provided, total quantities were divided or multiplied according the frequency with which the method is taken per month or the numbers of months of contraception provided.

RESULTS

Prescription of the combined oral contraceptive pill reduced by 22% during the period of lockdown compared to the same three months in 2019. Prescriptions of Progestogen-Only pills remained stable. Prescription of long-acting methods reduced, with the greatest reductions in implants (76% reduction from pre-lockdown levels), intra-uterine systems (79% reduction from pre-lockdown levels) and intrauterine devices (76% reduction from pre-lockdown levels).

CONCLUSIONS

The disruption of face-to-face contraceptive consultations in General Practice during a COVID-19 'lockdown' has resulted in a reduction in oestrogen -containing methods compared to progestogen-only methods, which require less face-to-face monitoring. Implant and intrauterine contraceptive device prescription reduced by three quarters over the first three months of lockdown, which has the potential to result in a rise in unintended pregnancies.

Impact of COVID-19 on the Use of Emergency Contraceptives in Ghana: An Interrupted Time Series Analysis

The Coronavirus disease pandemic has disrupted reproductive health services including decline in the use of pre-coital contraceptives. However, evidence of its impact on the use of emergency contraceptives, often, post-coital methods, is limited in the emerging literature, hence this study. Data on total number of emergency contraceptive users from January 2018 to February 2020 (pre-pandemic) and March to December 2020 (during the pandemic) were extracted from the Ghana Health Service District Health Information Management System. Interrupted Time Series analysis was used to estimate the impact of the pandemic on the trend of emergency contraceptive use, adjusting for serial autocorrelation and seasonality. The results showed a gradual upward trend in emergency contraceptive use before the pandemic, increasing at a rate of about 67 (95% CI 37.6–96.8; p = 0.001) users per month. However, the pandemic caused a sudden spike in the use of emergency contraceptives. The pandemic and its related restrictions had an immediate effect on the use of emergency contraceptives, increasing significantly by about 1939 users (95% CI 1096.6–2781.2; p = 0.001) in March 2020. Following March 2020, the number of emergency contraceptive users continued to increase by about 385 users per month (95% CI 272.9–496.4; p = 0.001). The evidence shows that use of emergency contraceptives, often used as post-coital methods for unprotected sex was not negatively impacted by the pandemic. In fact, it is the opposite. Hence, in planning for similar situations attention should be given to the distribution of post-coital contraceptive methods.

Effects of the COVID-19 pandemic on sexual functioning and activity: a systematic review and meta-analysis

BACKGROUND

Since December 2019, when it was first reported in Wuhan, province of Hubei, China, the new virus SARS-CoV-2 has spread rapidly around the world and has become a global pandemic. During the COVID-19 pandemic, due to the public health measures implemented, people's sexual activity has also been affected. Restrictions on people's activities, reduced sports activities, economic issues, increased psychological stress, and reduced entertainment have, indeed, dramatically impacted sexual activity and functioning. The purpose of this study was tosystematically identify, collect and summarize the existing body of evidence from published studies on the effects of COVID-19 pandemic on sexual activity and functioning.

METHODS

Several scholarly databases, namely MEDLINE (via PubMed interface), Web of Science (WOS), Embase, CINAHL, the Cochrane Library, Scopus, and PsycINFO databases, were mined from December 2019 to the end of January 2021. We utilized a random-effect meta-analytical model to analyze all the data. More in detail, the Standardized Mean Difference (SMD) was used in order to estimate and evaluate the effects of the COVID-19 pandemic on sexual activity and functioning.

RESULTS

Twenty-one studies were included in the present study. In total, 2454 women and 3765 men were evaluated. In the present meta-analysis, sexual functioning and activity were assessed by means of two standardized and reliable tools, namely the "Female Sexual Function Index" (FSFI) and the "International Index of Erectile Function-5 items" (IIEF-5). A total of 5 studies reported the FSFI score before and after the COVID-19 pandemic in female participants. Based on the random-effect model, the SMD was computed to be - 4.26 [95% confidence interval or CI: - 7.26, - 1.25], being statistically significant. A total of 3 studies reported the IIEF-5 score before and after the COVID-19 pandemic in male participants. Based on the random-effect model, the SMD was computed to be - 0.66 [CI 95%: - 0.99, - 0.33], being statistically significant. In the majority of these studies, participants reported a reduction in the number of sexual relations and an increase in the frequency of solo sex activity, especially masturbation, compared to the time prior to the COVID-19 pandemic.

CONCLUSION

The results of the present study showed that COVID-19 related restrictions were correlated with higher rates of sexual dysfunction and reduced sexual activity; however, results of the current meta-analytical study show that this change in sexual functioning was greater in women compared to men. Sex is one of the dimensions of every person's life; therefore, researchers should identify the factors that lead to sexual dysfunction due to COVID-19 pandemic in their community. In this regard, sexologists should design and implement effective programs to reduce the heterogeneous causes affecting sexual functioning, given the psychological strain that the COVID-19 pandemic puts on individuals.

Etonogestrel-releasing contraceptive implant in a patient using thalidomide for the treatment of erythema nodosum leprosum: a case report

INTRODUCTION

Thalidomide is an immunomodulatory drug and first choice in the treatment of erythema nodosum leprosum. Given its teratogenic potential, it is essential that an effective contraceptive method is used, especially a long-acting reversible contraceptive (LARC) method. The subdermal etonogestrel (ENG)-releasing implant is an adequate method due to the high effectiveness and long-term use. However, interaction between thalidomide and ENG has not been well documented. Concern arises because thalidomide interacts with cytochrome P450 (CYP450) enzymes that metabolize sexual steroids. AIM: We aimed to study the effectiveness and safety of the ENG-implant in a thalidomide user.

METHODS

Case report of a sexually active 21-year-old patient with both Hansen's disease and leprosy reaction type 2 treated with thalidomide requiring effective contraception. Follow-up was up to 36 months after implant placement.

RESULTS

Contraception with ENG-implant was effective and safe, based on clinical parameters (reduction of menstrual flow and cervical mucus thickening) and laboratory parameters (gonadotropins and sexual steroids).

CONCLUSION

To the best of our knowledge, this is the first case reported which presents a patient in simultaneous use of thalidomide and ENG-implant. Although this case report preliminary supports effectiveness and safety of ENG-implant as a contraceptive option in women using thalidomide, rigorous drug-drug interaction research is needed to better characterize the interaction between thalidomide and the ENG-implant.

Unintended pregnancy and associated factors during COVID-19 pandemic in Ethiopia: Community-based cross-sectional study

Introduction:

The term ‘unintended pregnancy’ refers to a pregnancy that occurred when no children were desired or occurred earlier than desired. Unintended births account for one out of every three births in Ethiopia, and they are the leading cause of maternal morbidity and mortality. During the coronavirus disease (COVID-19) pandemic, this could be useful. COVID-19 has a significant impact on maternal health care utilization, including family planning services. As a result, this study aimed to assess unintended pregnancy and associated factors in Ethiopia during the COVID-19 pandemic.

Method:

A community-based cross-sectional study was conducted in Gedeo zone, Ethiopia, from April 1 to May 30, 2021. A simple random sampling technique was utilized to get 383 pregnant women from their respective kebeles. A structured questionnaire was used to collect data during a face-to-face interview. The data were coded, cleaned, and entered into Epidemiological Data Version 3.1 before being exported to the Statistical Package for Social Science Version 23.0 for analysis. A bivariate and multivariable logistic regression model was used to identify statistically significant associations between dependent and independent variables. The odds ratio, with a 95% confidence interval and a P value of 0.05%, was considered statistically significant.

Result:

A total of 383 pregnant women participated in the study, giving a response rate of 90.8%. During the COVID-19 pandemic, 140 (36.6%) participants stated that their current pregnancy was unintended. Unintended pregnancy was significantly associated with respondents’ age (adjusted odds ratio (AOR) = 5.214 (1.449–18.762)), primary decision maker for family planning services (AOR = 9.510 (5.057–17.887)), and fear of COVID-19 to visit a health care facility (AOR = 7.061 (2.665–18.710)).

Conclusion:

During the COVID-19 era, more than one-third of women had unintended pregnancies. Unintended pregnancy was significantly associated with respondents’ age, autonomy to use contraceptive methods, and fear of COVID-19, which required them to attend a health care institution.

Contracepção Reversível de Longa Duração (Larc): solução ideal para tempos pandêmicos?

RESUMO O artigo discute uma correlação muito frequente notada a partir do desencadeamento da pan- demia de Covid-19 no mundo e no Brasil, ou seja, maior abertura e incentivo aos métodos Contraceptivos Reversíveis de Longa Duração (Larc) em decorrência das restrições sociais trazidas pela crise sanitária. De certa forma, a gravidade da pandemia justifica social e humanitariamente o recurso mais sistemático aos métodos de longa duração, na tentativa de evitar uma gravidez imprevista. A pesquisa antropológica se apoia em vasto material empírico documental no sentido de analisar e compreender as lógicas sociais subjacentes a esses expedientes, amplamente disseminados em contextos de pobreza e de precariedade social. A ampliação da oferta de métodos contraceptivos nos sistemas públicos de saúde é sempre desejável, respeitando-se a autonomia reprodutiva das mulheres e sua liberdade para escolher e decidir o que melhor lhes convém em determinado momento de sua vida. O problema reside na compreensão generalizada de que nem todas as mulheres têm condições para escolher e decidir, devendo ser ‘aconselhadas’ a aceitar um método de longa duração, por razões médicas/de saúde. Os limites tênues entre autodeterminação e coerção ou compulsoriedade obrigam a refletir sobre quão arriscada pode se tornar essa aposta.

A gendered content analysis of the World Health Organization's COVID-19 guidance and policies

As with previous global public health emergencies, the COVID-19 pandemic has had distinct and disproportionate impacts on women and their health and livelihoods. As the leader in global public health, it is incumbent upon the World Health Organization (WHO) to ensure gender is prioritized in pandemic response. We conducted a policy analysis of 338 WHO COVID-19 documents and found that only 20% explicitly discuss gender and over half do not mention women, gender, or sex at all. Considering the well documented gendered effects of pandemics and the WHO's commitment to gender mainstreaming, this paper: 1) asks to what degree and how the WHO incorporates a gender inclusive approach; 2) maps where and how gender considerations are included; and 3) analyses what this suggests about WHO's commitment to gender mainstreaming within its COVID-19 response and beyond. We demonstrate that WHO should increase its gender mainstreaming efforts and incorporate gender considerations related to health emergencies more often and in more policy areas.

The prevalence of Implanon discontinuation and associated factors among Ethiopian women: A systematic review and meta-analysis

Background:

Implanon discontinuation before the recommended time is problematic, as it puts women at risk of unwanted pregnancies and unsafe abortions, along with negative maternal health outcomes. Although the magnitude and determinants of Implanon discontinuation have been studied in Ethiopia, the results were inconsistent, with significant variability. Hence, this systematic review and meta-analysis aimed at estimating the pooled prevalence of Implanon discontinuation and its determinants in Ethiopia.

Methods:

A comprehensive search of studies published before 18 February 2022 was done using electronic databases such as PubMed, Embase, Google Scholar, Scopus, Web of Science, Science Direct, and Cochrane Library. The relevant data were extracted using a Microsoft Excel 2013 and analyzed using STATA Version 16. A random-effect meta-analysis model was used to compute pooled prevalence and odds ratio. The Cochrane Q test statistics and I² tests were used to assess the heterogeneity of the included studies. A funnel plot, Begg’s, and Egger’s tests were used to check for the presence of publication bias.

Results:

A total of 11 studies with 4320 study participants were included in this meta-analysis. The overall pooled prevalence of Implanon discontinuation in Ethiopia was found to be 32.62% (95% confidence interval = 24.10, 41.13). There was significant heterogeneity among the included studies (I² = 97.4%, p < 0.001). However, there was no statistical evidence of publication bias (p = 0.533). Dissatisfied with service provision at the time of insertion (odds ratio = 3.92, 95% confidence interval = 1.54, 6.29), not having pre-insertion counseling (odds ratio = 2.98, 95% confidence interval = 1.91, 5.04), the absence of post-insertion follow-up (odds ratio = 4.03, 95% confidence interval = 2.17, 5.90), and the presence of side effects (odds ratio = 2.93, 95% confidence interval = 1.87, 3.98) were found to be determinants of Implanon discontinuation.

Conclusion:

According to this systematic review and meta-analysis, one-third of Ethiopian women discontinued Implanon before the recommended time (3 years). Program managers and service providers should consider using more evidence-based and participatory counseling approaches to enhance client satisfaction. Furthermore, family planning service delivery points should be equipped to manage and reassure women who are experiencing side effects.

Competing Health Risks Associated with the COVID-19 Pandemic and Early Response: A Scoping Review

BACKGROUND

COVID-19 has rapidly emerged as a global public health threat with infections recorded in nearly every country. Responses to COVID-19 have varied in intensity and breadth, but generally have included domestic and international travel limitations, closure of non-essential businesses, and repurposing of health services. While these interventions have focused on testing, treatment, and mitigation of COVID-19, there have been reports of interruptions to diagnostic, prevention, and treatment services for other public health threats.

OBJECTIVES

We conducted a scoping review to characterize the early impact of COVID-19 on HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition.

METHODS

A scoping literature review was completed using searches of PubMed and preprint servers (medRxiv/bioRxiv) from January 1st to October 31st, 2020, using Medical Subject Headings (MeSH) terms related to SARS-CoV-2 or COVID-19 and HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. Empiric studies reporting original data collection or mathematical models were included, and available data synthesized by region. Studies were excluded if they were not written in English.

RESULTS

A total of 1604 published papers and 205 preprints met inclusion criteria, including 8.2% (132/1604) of published studies and 10.2% (21/205) of preprints: 7.3% (68/931) on HIV, 7.1% (24/339) on tuberculosis, 11.6% (26/224) on malaria, 7.8% (13/166) on sexual and reproductive health, and 9.8% (13/132) on malnutrition. Thematic results were similar across competing health risks, with substantial indirect effects of the COVID-19 pandemic and response on diagnostic, prevention, and treatment services for HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition.

DISCUSSION

COVID-19 emerged in the context of existing public health threats that result in millions of deaths every year. Thus, effectively responding to COVID-19 while minimizing the negative impacts of COVID-19 necessitates innovation and integration of existing programs that are often siloed across health systems. Inequities have been a consistent driver of existing health threats; COVID-19 has worsened disparities, reinforcing the need for programs that address structural risks. The data reviewed here suggest that effective strengthening of health systems should include investment and planning focused on ensuring the continuity of care for both rapidly emergent and existing public health threats.

COVID-19, gender and estroprogestins, what do we know?

The new coronavirus disease-19 (COVID-19) pandemic has rapidly spread all around the world, eliciting many questions and doubts about the pathogenesis of the disease and treatment. Mortality has been related to a prothrombotic state. Risk factors for the infection and for severe forms of COVID-19 have still to be defined. According to data collected, women appear to be less prone to severe forms of the disease and their mortality was lower than for men. The role of female hormones in the modulation of inflammation may be the reason behind this gender gap.Considering the prothrombotic state activated by the virus, hormone therapies have been placed under investigation as possible increasing risk factors for severe forms. Moreover, new vaccines and their rare thrombotic side effects have increased the concern about this issue.The goal of this review is to go over the mechanisms that lead up to thrombosis during COVID-19, trying to explain the possible reasons why women seem to be naturally protected. The expert opinions about whether to continue/discontinue hormonal therapies are reviewed. Moreover, available data about the so-called 'vaccine induced immune thrombotic thrombocytopaenia' caused by vaccines against COVID-19 are discussed.

Factors associated with access to condoms and sources of condoms during the COVID-19 pandemic in South Africa

BACKGROUND

Evidence has shown that the prescribed lockdown and physical distancing due to the novel coronavirus disease 2019 (COVID-19) have made accessing essential health care services much more difficult in low-and middle-income countries. Access to contraception is an essential service and should not be denied, even in a global crisis, because of its associated health benefits. Therefore, it is important to maintain timely access to contraception without unnecessary barriers. Hence, this study examines the factors contributing to limited access to condoms and sources of condoms during the COVID-19 pandemic in South Africa.

METHODS

This study used the National Income Dynamics Study-Coronavirus Rapid Mobile Survey (NIDS-CRAM) wave 1 survey dataset. The NIDS-CRAM is a nationally representative survey of the National Income Dynamics Survey (NIDS) conducted via telephone interview during COVID-19 in the year 2020. This is the first secondary dataset on COVID-19 conducted by NIDS during pandemic. A total of 5304 respondents were included in the study. Data were analysed using frequencies distribution percentages, chi-square test and multivariable logistic regression analysis.

RESULTS

Almost one-quarter (22.40%) of South Africans could not access condoms, and every 7 in 10 South Africans preferred public source of condoms during the COVID-19 pandemic. Those who were from other population groups [AOR = 0.37; 95% CI = 0.19-0.74] and those who were in the third wealth quintile [AOR = 0.60; 95% CI = 0.38-0.93] had lower odds of having access to condoms while those respondents who were aged 25-34 [AOR = 0.48; 95% CI = 0.27-0.83] and those with a secondary level of education and above [AOR = 0.24; 95% CI = 0.08-0.71] were less likely to prefer public source of condom.

CONCLUSIONS

This study concludes that there was limited access to condoms during the COVID-19 pandemic and that the preferred source of condoms was very skewed to public sources in South Africa. Strategic interventions such as community distribution of free condoms to avert obstruction of condom access during the COVID-19 pandemic or any future pandemics should be adopted.

Pediatric Hospital Readmissions for Infants With Neonatal Opioid Withdrawal Syndrome, 2016-2019

BACKGROUND AND OBJECTIVES

Neonatal opioid withdrawal syndrome (NOWS) is associated with long and costly birth hospitalization and increased readmission risk. Our objective was to examine readmissions in the first year of life for infants diagnosed with NOWS compared with infants without NOWS, adjusting for sociodemographic and clinical factors, and to describe use during readmissions in this population.

METHODS

Using data from the Pediatric Health Information System, we identified singleton term infants with NOWS and without NOWS or other major condition (by diagnosis codes and All Patient Refined Diagnosis Related Groups coding, respectively) discharged from 2016 to 2019. We predicted time to first readmission within the first year of life using Cox regression analysis. Predictors included NOWS diagnosis, sociodemographic factors, birth NICU use, and birth weight.

RESULTS

We included 155 885 birth discharges from 17 hospitals (n = 1467 NOWS) with 10 087 readmissions. Unadjusted 1-year readmission rates were 9.9% among NOWS infants versus 6.2% among those without NOWS. The adjusted hazard ratio for readmission within the first year was 1.76 (95% confidence interval: 1.40-2.22) for infants with NOWS versus those without. Readmissions for infants with NOWS were longer and costlier and more likely to require intensive care and mechanical ventilation. Readmissions among infants without NOWS were most commonly for jaundice and respiratory and other infections, whereas respiratory infections were the leading cause of readmissions among NOWS infants.

CONCLUSIONS

Infants with a NOWS diagnosis were more likely to be readmitted within the first year of life. In future work, researchers should explore potential interventions to prevent readmissions and provide resources to families affected by opioid dependence.

Evaluation of coagulation parameters: Coronavirus disease 2019 (COVID-19) between survivors and nonsurvivors

OBJECTIVE

This study aims to investigate and compare the coagulation parameters of coronavirus disease 2019 (COVID-19) patients with mortal and nonmortal conditions.

METHODS

In this study, 511 patients diagnosed with COVID-19 were included. Information about 31 deceased and 480 recovered COVID-19 patients was obtained from the hospital information management system and analyzed retrospectively. Whether there was a correlation between coagulation parameters between the mortal and nonmortal patients was analyzed. Descriptive analyses on general characteristics of the study population were performed. Visual (probability plots and histograms) and analytical methods (Kolmogorov-Smirnov and Shapiro-Wilk test) were used to test the normal distribution. Analyses were performed using the SPSS statistical software package.

RESULTS

Out of 511 patients, 219 (42.9%) were females and 292 (57.1%) were males. There was no statistically significant difference between males and females in terms of mortality (p=0.521). In total, the median age was 67 (22). The median age was 74 (13) in the nonsurvivor group and 67 (22) in the survivor group, and the difference was statistically significant (p=0.007). The D-dimer, prothrombin time, international normalized ratio, neutrophil, and lymphocyte median age values with p-values, in the recovered and deceased patient groups were: 1070 (2129), 1990 (7513) μg FEU/L, p=0.005; 12.6 (2.10), 13.3 (2.1), p=0.014; 1.17 (0.21), 1.22 (0.19), p=0.028; 5.51 (6.15), 8.54 (7.05), p=0.001; and 0.99 (0.96), 0.64 (0.84), p=0.037, respectively, with statistically significant differences.

CONCLUSIONS

As a result of this study, D-dimer, prothrombin time, and international normalized ratio increase were found to be associated with mortality. These parameters need to be closely monitored during the patient follow-up.

More than just contraception: the impact of the levonorgestrel-releasing intrauterine system on public health over 30 years

Universal access to sexual and reproductive health services is essential to facilitate the empowerment of women and achievement of gender equality. Increasing access to modern methods of contraception can reduce the incidence of unplanned pregnancy and decrease maternal mortality. Long-acting reversible contraceptives (LARCs) offer high contraceptive efficacy as well as cost-efficacy, providing benefits for both women and healthcare systems. The levonorgestrel-releasing intrauterine system (LNG-IUS) first became available in 1990 with the introduction of Mirena (LNG-IUS 20), a highly effective contraceptive which can reduce menstrual blood loss and provide other therapeutic benefits. The impact of the LNG-IUS on society has been wide ranging, including decreasing the need for abortion, reducing the number of surgical sterilisation procedures performed, as well as reducing the number of hysterectomies carried out for issues such as heavy menstrual bleeding (HMB). In the context of the COVID-19 pandemic, Mirena can provide a treatment option for women with gynaecological issues such as HMB without organic pathology, minimising exposure to the hospital environment and reducing waiting times for surgical appointments. Looking to the future, research and development in the field of the LNG-IUS continues to expand our understanding of these contraceptives in clinical practice and offers the potential to further expand the choices available to women, allowing them to select the option that best meets their needs.

Impact of the Lockdown Due to COVID-19 Pandemic in the Use of Combined Hormonal Oral Contraception in Spain - Results of a National Survey: Encovid

Objective

To know the contraceptive behaviour of Spanish women who use combined oral contraception (COC) during the period of lockdown due to COVID-19.

Methods

Cross-sectional, descriptive study of a sample of Spanish women who use COC based on a survey conducted through social networks using the online platform Survey Monkey. The survey was conducted during the period of home confinement.

Results

A total of 1407 women answered the survey and 937 were valid for the analysis. A total of 675 women (71.8%) were confined all day at home. During confinement 96,6% of women continued to use the COC, 53.5% responded that their sexual activity decreased during this time and 54% that their physical activity had decreased. A significant percentage of women (10.3%) recognized a worsening of premenstrual symptoms.

Conclusion

Despite the lockdown and the decrease in the frequency of sexual intercourse, the Spanish women who use COC did not abandon its use during the period of time analysed.

Unintended Pregnancy During COVID-19 Pandemic Among Women Attending Antenatal Care in Northwest Ethiopia: Magnitude and Associated Factors

Background

COVID-19 pandemic has a great impact on the disruption of maternal health-care services. Family planning is one component of maternal health-care service that needs attention during this devastating time. Compromise on family planning services and the preventive strategies of COVID-19 might increase the burden of unintended pregnancy, but there is limited evidence that shows the magnitude of unintended pregnancy during the COVID-19 pandemic. Therefore, the objective of this study was to assess unintended pregnancy during the COVID-19 pandemic and its associated factors among women attending antenatal care in northwest Ethiopia.

Methods

This study was an institutional-based cross-sectional study, including 424 women attending antenatal care from November 12/2020 to December 12/2020. The study participants were selected using a systematic random sampling technique. A pretested questionnaire was used. Binary logistic regression (bivariable and multivariable) was employed. The adjusted odds ratio with a 95% confidence interval was used to declare statistically significant variables based on p<0.05 in the multivariable logistic regression model.

Results

The magnitude of unintended pregnancy during the COVID-19 pandemic among women attending antenatal care was found to be 47.17% (42.2–52.2%). Women did not expose to community education (AOR=2.2; 95% CI1.1–4), women with no bad obstetric history (AOR=2.3; 95% CI1.3–4.1), a woman was not the primary decision maker for family planning service (AOR=2.9; 95% CI 1.5–5.7), no complication during index pregnancy (AOR=5.4; 95% CI 2.2–13) and women with no health-care provider support (AOR=2.4, 95% CI1.4–3.9) were significantly associated with unintended pregnancy.

Conclusions

The magnitude of unintended pregnancy was found to be high. Community education about maternal health services including family planning, improving women’s decision-making power for maternal health-care services, giving emphasis on pregnancy-related complications with health-care provider support, and pregnant women with bad obstetric history were suggested to reduce the problem.

Contraceptive use and pregnancy plans among women of reproductive age during the first Australian COVID-19 lockdown: findings from an online survey

PURPOSE

Australia introduced 'lockdown' measures to control COVID-19 on 22 March 2020 which continued for a period of two months. We aimed to investigate the impact this had on sexual and reproductive health (SRH).

MATERIALS AND METHODS

Australians aged 18+ were eligible to participate in an online survey from 23 April to 11 May 2020. We report on the experiences of 518 female participants aged <50 years. Pregnancy intentions and contraceptive use were analysed using descriptive statistics. Odds ratios and 95% confidence intervals were calculated to investigate difficulty accessing SRH products and services. Qualitative data were analysed using conventional content analysis.

RESULTS

Most participants were aged 18-24 years, and indicated they were trying to avoid pregnancy. The oral contraceptive pill was the most common single method used however nearly 20% reported they were not using contraception. Women who were employed had less trouble accessing contraception during lockdown. Participants reported delaying childbearing or deciding to remain childfree due to COVID-19.

CONCLUSION

COVID-19 lockdown impacted the SRH of Australian women. Findings highlight the importance of continued access to SRH services and products during global emergencies.

Combined hormonal contraception and COVID-19

Aim: This article reviews the possibility of using combined hormonal contraception during the COVID-19 pandemic. Methods: narrative reviewResults: The factors that protect women from the severity of the disease are analysed, as well as the risk factors for the use of this type of contraception, especially related to the increased risk of a thrombotic event in patients affected by the disease. Finally, the information available on the guidelines for action in patients with COVID-19 using combined hormonal contraception is collected.Conclusions: We can continue to prescribe and use hormonal methods with EE.

Smoking and comorbidities are associated with COVID-19 severity and mortality in 565 patients treated in Turkey: a retrospective observational study

OBJECTIVE

We aimed to explore the prevalence of smoking rates and comorbidities and evaluate the relationship between them and disease severity and mortality in inpatients with COVID-19.

METHODS

COVID-19 patients were divided into the following groups: clinic group, intensive care unit (ICU) group, survivors, and non-survivors. Non-COVID-19 patients were included as a control group. The groups were compared.

RESULTS

There was no difference between patients with and without COVID-19 in terms of smoking, asthma, diabetes, dementia, coronary artery disease (CAD), hypertension, chronic renal failure and arrhythmia (p>0.05). Older age (Odds ratio (OR), 1.061; 95% confidence interval (CI): 1.041-1.082; p< 0.0001), chronic obstructive pulmonary disease (COPD) (OR, 2.775; 95% CI: 1.128-6.829; p=0.026) and CAD (OR, 2.696; 95% CI: 1.216-5.974; p=0.015) were significantly associated with ICU admission. Current smoking (OR, 5.101; 95% CI: 2.382-10.927; p<0.0001) and former smoking (OR, 3.789; 95% CI: 1.845-7.780; p<0.0001) were risk factors for ICU admission. Older age (OR; 1.082; 95% CI: 1.056-1.109; p<0.0001), COPD (OR, 3.213; 95% CI: 1.224-8.431; p=0.018), CAD (OR, 6.252; 95% CI: 2.171-18.004; p=0.001) and congestive heart failure (CHF) (OR, 5.917; 95% CI 1.069-32.258; p=0.042), were significantly associated with mortality. Current smoking (OR, 13.014; 95% CI: 5.058-33.480; p<0.0001) and former smoking (OR, 6.507; 95% CI 2.731-15.501; p<0.0001) were also risk factors for mortality.

CONCLUSION

Smoking, older age, COPD, and CAD were risk factors for ICU admission and mortality in patients with COVID-19. CHF was not a risk factor for ICU admission; however, it was a risk factor for mortality.

Sexual activity and contraceptive use during social distancing and self-isolation in the COVID-19 pandemic

OBJECTIVES

The aims of the study were to investigate the effects of social distancing during the COVID-19 pandemic on the use of hormonal contraceptives, their discontinuation and the risk of unplanned pregnancy.

METHODS

The study enrolled 317 women listed in the database of the Department of General Surgery and Medical-Surgical Specialties, University of Catania, Italy, family planning clinic who were known to be using hormonal contraceptives. The women were contacted by telephone and asked whether they would like to participate in the study. If they agreed, they were then emailed a questionnaire about their social behaviour and sexual activity during the pandemic, according to their cohabiting status, i.e., whether they were continuing to use their hormonal contraception and whether they had had an unplanned pregnancy.

RESULTS

The questionnaire was completed by 175 (81.8%) women who were using short-acting reversible contraception (SARC) and by 90 (87.4%) women who were using long-acting reversible contraception (LARC). All married and cohabiting women were continuing to use their contraceptive method. None had had an unplanned pregnancy. On the other hand, 51 (50.5%) non-cohabiting or single women had discontinued their SARC method while social distancing, for non-method-related reasons; however, 47 (46.5%) non-cohabiting or single women had continued their sexual activity, infringing social distancing rules, and 14.9% had had an unplanned pregnancy, for which they had sought a termination.

CONCLUSION

Several non-cohabiting women using SARC had discontinued their contraceptive method during the pandemic but had continued to engage in sexual activity and had had an unplanned pregnancy. Clinicians should counsel women about what they should do in regard to contraception in the event of new, future social distancing measures.

The impact of COVID-19 lockdown in a developing country: narratives of self-employed women in Ndola, Zambia

Women are normally self-employed in businesses involving buying and selling of goods. Such businesses were severely affected by the COVID-19 pandemic lock-down. The researchers explored the impact the of COVID-19 lockdown on self-employed women. The researchers used a qualitative approach. Interviews were used to collect data. Forty participants took part in the study. The data was thematically analyzed. The researchers found that participants were affected by Inadequate food supplies, Hopelessness to revive business, Poor access to health services, Psychological trauma, Defaulting medications, and Challenges of keeping children indoors. There is need to provide social and economic support to self-employed women.

Consensus on Recommendations for Safe Sexual Activity during the COVID-19 Coronavirus Pandemic

Sexual activity offers numerous advantages for physical and mental health but maintains inherent risks in a pandemic situation, such as the current one caused by SARS-CoV-2. A group of experts from the Spanish Association of Sexuality and Mental Health (AESexSAME) has reached a consensus on recommendations to maintain lower-risk sexual activity, depending on one's clinical and partner situations, based on the current knowledge of SARS-CoV-2. Different situations are included in the recommendations: a sexual partner passing quarantine without any symptoms, a sexual partner that has not passed quarantine, a sexual partner with some suspicious symptoms of COVID-19, a positive sexual partner with COVID-19, a pregnant sexual partner, a health professional partner in contact with COVID-19 patients, and people without a sexual partner. The main recommendations include returning to engaging in safe sex after quarantine is over (28 days based on the duration one can carry SARS-CoV-2, or 33 days for those who are >60 years old) and all parties are asymptomatic. In all other cases (for those under quarantine, those with some clinical symptoms, health professionals in contact with COVID-19 patients, and during pregnancy), abstaining from coital/oral/anal sex, substituting it with masturbatory or virtual sexual activity to provide maximum protection from the contagion, and increasing the benefits inherent to sexual activity are recommended. For persons without a partner, not initiating sexual activity with a sporadic partner is strongly recommended.

Desigualdades de gênero e raça na pandemia de Covid-19: implicações para o controle no Brasil

RESUMO Esta revisão narrativa sintetizou evidências científicas sobre desigualdades de gênero e raça na pandemia de Covid-19, enfocando o trabalho produtivo/reprodutivo das mulheres, a violência de gênero e o acesso aos Serviços de Saúde Sexual e Reprodutiva (SSR). Os resultados confirmam que as desigualdades sociais devem ser consideradas para o efetivo controle da pandemia e para a preservação de direitos. Para além dos efeitos diretos do SARS-CoV-2, discute-se que barreiras de acesso a serviços de SSR podem ocasionar o aumento de gravidezes não pretendidas, abortos inseguros e mortalidade materna. O distanciamento social tem obrigado muitas mulheres a permanecer confinadas com seus agressores e dificultado o acesso a serviços de denúncia, incorrendo no aumento da violência de gênero e em desfechos graves à saúde. Como principais responsáveis pelo cuidado, as mulheres estão mais expostas a adoecer nas esferas profissional e doméstica. A conciliação trabalho-família tornou-se mais difícil para elas durante a pandemia. A literatura naturaliza as diferenças de gênero, raça e classe, com ênfase em fatores de risco. Uma agenda de pesquisa com abordagem interseccional é necessária para embasar a formulação de políticas que incorporem os direitos humanos e atendam às necessidades dos grupos mais vulneráveis à Covid-19.