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McGuire C, Atieno MA, Hoke T, Jeckonia P, K'orimba K, Lorenzetti L, Ngure K, Niyibeshaho MM, Njuguna N, Torjesen K, Fonner V. PrEP Method Switching: Will it Yield Greater Coverage of HIV Protection? Applying Lessons Learned from Family Planning to Guide Future Research in the Context of PrEP Choice. Curr HIV/AIDS Rep 2024; 21:282-292. [PMID: 39046639 DOI: 10.1007/s11904-024-00704-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE OF REVIEW Despite the growing availability of oral PrEP, coverage remains suboptimal. Through the introduction of additional PrEP methods, including vaginal rings and long-acting injectable formulations, health systems globally are on the cusp of offering PrEP methods that vary by route of administration, efficacy, and frequency of use. With PrEP choice, it will be important to explore PrEP use patterns to better understand how the ability to choose and switch products affects coverage and continuation. In this review, we draw parallels with family planning (FP) by summarizing how method choice and product switching affected contraceptive coverage globally, synthesize what is known about PrEP product switching, and outline evidence gaps to help guide future research on PrEP switching in the context of choice. RECENT FINDINGS Decades of research in FP has demonstrated that product switching is common and can lead to more satisfaction and increases in contraceptive use. While research on PrEP product switching is nascent, findings suggest switching is common, and that providing more than one PrEP option can increase coverage. Key evidence gaps include understanding product switching in the context of full versus constrained choice, switching in the context of temporary need, and developing interventions that promote product switching for those who could benefit. Providing choice and allowing people to start, stop, and switch products according to their needs and desires is a core component of a rights-based approach to HIV prevention. More research is needed to better understand what drives use patterns, including switching, and how to leverage choice to improve coverage. Standard definitions -some of which have been proposed in this review-are needed to inform comparable measurement. Finally, there is a need to holistically frame PrEP use to acknowledge changes in need over the life course, thus making method switching a standard part of HIV prevention.
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Affiliation(s)
- Courtney McGuire
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA.
| | | | - Theresa Hoke
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
| | | | | | - Lara Lorenzetti
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, USA
| | | | | | | | - Virginia Fonner
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
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Silberg C, Moreau C, Karp C, Bazié F, Gichangi P, Guiella G, Onadja Y, Thiongo M, Anglewicz P. Trends in Adolescent Sexual and Reproductive Health Outcomes Before and Into the COVID-19 Pandemic in Burkina Faso and Kenya: Evidence From Panel Data. J Adolesc Health 2024; 75:344-352. [PMID: 38878048 PMCID: PMC11252117 DOI: 10.1016/j.jadohealth.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE Many predicted that COVID-19 would have a substantial impact on the sexual and reproductive health (SRH) trajectories of adolescents in sub-Saharan Africa. The lack of longitudinal data with information collected before and into the pandemic has limited investigation into this topic. METHODS We performed a secondary analysis using nationally representative longitudinal data from Kenya and Burkina Faso, collected at three time points (pre-COVID-19 in late 2019, and during COVID-19 in 2020 and 2021), to determine the extent to which SRH outcomes and behaviors, including pregnancy, contraceptive use, partnership status, and sexual activity, changed during the pandemic among adolescent women. RESULTS Among adolescents aged 15-19 years (Kenya n = 1,893, Burkina Faso n = 1,422), there was a reduction in both partnership and pregnancy in 2021 as compared to pre-COVID 2019. Contraception use significantly increased between 2019 and 2021 in Kenya only (adjusted odds ratio [aOR]: 1.42, 95% confidence interval [CI] 1.03-1.97). COVID-19-related household income loss was associated with a decline in sexual activity among unmarried Kenyan girls (aOR: 0.47, 95% CI 0.25-0.87) and lower odds of pregnancy in Burkina Faso (aOR: 0.13, 95% CI 0.02-0.91). We did not find a relationship between COVID-19 measures and initiation of partnership or marriage in either setting. DISCUSSION Contrary to expectations, our results suggest that COVID-19 did not have a consistent or sustaining impact on adolescent SRH and behaviors in Burkina Faso and Kenya. Further research is needed to assess the longer-term implications of the pandemic on adolescent social and health outcomes.
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Affiliation(s)
- Claire Silberg
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Celia Karp
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Fiacre Bazié
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph KI-Zerbo, Ouagadougou, Burkina Faso
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph KI-Zerbo, Ouagadougou, Burkina Faso
| | - Yentéma Onadja
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph KI-Zerbo, Ouagadougou, Burkina Faso
| | - Mary Thiongo
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya; Technical University of Mombasa, Mombasa, Kenya
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
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Joseph G, Kobi-Jackson S, Birmingham M, Champetier de Ribes G, De Mucio B, Colomar M, Sosa C, Alfred JP, Thermidor R. Changes in reproductive, maternal, and child health in Haiti during the pre- and peri-COVID-19 pandemic. Rev Panam Salud Publica 2024; 48:e57. [PMID: 38859812 PMCID: PMC11164238 DOI: 10.26633/rpsp.2024.57] [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: 01/01/2024] [Accepted: 04/22/2024] [Indexed: 06/12/2024] Open
Abstract
Objective To assess changes in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in Haiti from August 2018 to September 2021, before and during the COVID-19 pandemic. Methods A retrospective study using surveillance data from the Haitian Unique Health Information System, examining two periods: pre- and peri-COVID-19 pandemic. Health indicators at the national level in the two periods were compared using two-sample t-tests for proportions, and average absolute monthly changes were calculated using variance-weighted regression. Results There was a statistically significant decline in the proportion of most of the indicators assessed from the pre- to the peri-COVID-19 pandemic period. However, the most affected indicators were the proportions of pregnant women with four antenatal care visits, with five antenatal care visits or more, and those who received a second dose of tetanus vaccine, which decreased by over 4 percentage points during the two periods. Likewise, the proportions of children who received diphtheria, tetanus, and pertussis (DTaP), BCG, polio, pentavalent, and rotavirus vaccines also all declined by over 8 percentage points. In contrast, pneumococcal conjugate vaccine increased by over 4 percentage points. A statistically significant decrease was also observed in the average absolute monthly changes of several reproductive and child health indicators assessed. Conclusions The COVID-19 pandemic may have contributed to the decline observed in several RMNCAH indicators in Haiti. However, the role played by the sociopolitical crisis and control exercised by armed groups over the population in the last three years cannot be ruled out.
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Affiliation(s)
- Gary Joseph
- University of GuyanaGeorgetownGuyanaUniversity of Guyana, Georgetown, Guyana
| | - Solange Kobi-Jackson
- Pan American Health OrganizationPort-au-PrinceHaitiPan American Health Organization, Port-au-Prince, Haiti
| | - Maureen Birmingham
- Pan American Health OrganizationPort-au-PrinceHaitiPan American Health Organization, Port-au-Prince, Haiti
| | - Gilles Champetier de Ribes
- Pan American Health OrganizationPort-au-PrinceHaitiPan American Health Organization, Port-au-Prince, Haiti
| | - Bremen De Mucio
- Latin American Center for PerinatologyWomen and Reproductive HealthMontevideoUruguayLatin American Center for Perinatology, Women and Reproductive Health, Montevideo, Uruguay
| | - Mercedes Colomar
- Latin American Center for PerinatologyWomen and Reproductive HealthMontevideoUruguayLatin American Center for Perinatology, Women and Reproductive Health, Montevideo, Uruguay
| | - Claudio Sosa
- Latin American Center for PerinatologyWomen and Reproductive HealthMontevideoUruguayLatin American Center for Perinatology, Women and Reproductive Health, Montevideo, Uruguay
| | - Jean Patrick Alfred
- Ministère de la Santé Publique et de la PopulationPort-au-PrinceHaitiMinistère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Roody Thermidor
- Ministère de la Santé Publique et de la PopulationPort-au-PrinceHaitiMinistère de la Santé Publique et de la Population, Port-au-Prince, Haiti
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Nayab, Ahmad T, Fatmee A, Sajjad I, Usmani Z, Khan A, Shahzad S, Khan AA. Utilization of social franchising in family planning services: a Pakistan perspective. Front Glob Womens Health 2024; 5:1376374. [PMID: 38826760 PMCID: PMC11140052 DOI: 10.3389/fgwh.2024.1376374] [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: 01/25/2024] [Accepted: 05/03/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction Pakistan's private sector caters to around 65% of family planning users. Private sector family planning was promoted in the Delivering Accelerated Family Planning in Pakistan (DAFPAK) program by UK's Foreign, Commonwealth & Development Office (FCDO) in 2019. We use data from DAFPAK to analyze the clientele and products distributed by two major NGOs, Marie Stopes Society (MSS) and DKT Pakistan, that support private providers in Pakistan. We also examined the effect of COVID-19 on client visits and contraceptives uptake at private facilities in Pakistan. Methods DAFPAK used field validation surveys to analyze the volume of clients and products of 639 private facilities across three provinces (Punjab, KPK and Balochistan) of Pakistan. The data was collected in two phases (February 2020 and 2021) using multi-stage cluster sampling at 95% confidence level. Using a generalized negative binomial regression, facility-level characteristics and impact of COVID-19 was analyzed with the volume of clients and products given out at 95% confidence interval alongside descriptive analysis. Results DKT facilities covered 53% of the sample while MSS covered 47%, with 72% facilities in the rural areas. Average facility existence duration is 87 months (7.25 years). While the average experience of the facility staff is 52 months (4.33 years). MSS is serving more clients as compared to DKT during both phase 1 (IRR: 3.15; 95% CI: 2.74, 3.61) and phase 2 (IRR: 2.11; 95% CI: 1.79, 2.49). Similarly, MSS had a greater volume of products given out in both phases 1 (IRR: 1.89; 95% CI: 1.51, 2.38) and phase 2 (IRR: 2.57; 95% CI: 2.09, 3.14). In both phases, client visits and product distribution decreased when client privacy is invaded (IRR: 0.74; 95% CI: 0.67, 0.82 - phase 1) and (IRR: 0.83; 95% CI: 0.72, 0.97 - phase 2). Lastly, during COVID-19, products distribution decreased by a factor of 0.84 (IRR: 0.84; 95% CI: 0.72, 0.97) but client visits remain unaffected. Conclusion Overall, clientele is low for all facilities. At a facility, privacy is a determinant of client visits and products given out per visit. Transiently, during COVID-19, client volumes decreased, with a shift from oral pills to condoms and emergency contraceptive pills.
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Affiliation(s)
- Nayab
- Program, Research and Development Solutions (RADS), Islamabad, Pakistan
| | - Taimoor Ahmad
- Program, Research and Development Solutions (RADS), Islamabad, Pakistan
| | - Areesh Fatmee
- Program, Research and Development Solutions (RADS), Islamabad, Pakistan
| | - Ibtisam Sajjad
- Program, Research and Development Solutions (RADS), Islamabad, Pakistan
| | - Zona Usmani
- Program, Research and Development Solutions (RADS), Islamabad, Pakistan
| | - Ayesha Khan
- Urban Impact Lab, Akhter Hameed Khan Foundation, Islamabad, Pakistan
| | - Sara Shahzad
- University of Cambridge, Cambridge, United Kingdom
| | - Adnan Ahmad Khan
- Program, Research and Development Solutions (RADS), Islamabad, Pakistan
- Ministry of National Health Services, Regulations and Coordination (MoNHSRC), Islamabad, Pakistan
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Hardee K, Rosenberg R, Ross J, Zosa-Feranil I. How resilient were family planning programs during the COVID-19 pandemic? Evidence from 70 countries. Gates Open Res 2024; 7:121. [PMID: 38784148 PMCID: PMC11111842 DOI: 10.12688/gatesopenres.14856.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 05/25/2024] Open
Abstract
Background At the beginning of the COVID-19 pandemic fears of severe disruptions to family planning (FP) and access to services abounded. This paper uses a unique data source, a special Supplement added to the 2021 round of the National Composite Index for Family Planning (NCIFP), to assess in depth the resilience of FP programs in the face of the COVID-19 pandemic across 70 countries spanning six regions. Methods The 2021 NCIFP included 961 key informants who were asked questions to assess interference in the countries' ability to achieve objectives, ability to maintain commitment to FP, and availability of information and services. Open ended responses added context. Results All programs were affected; the magnitude of effects varies by region and country. While the average resilience score, at 47 out of 100, implies middling levels of resilience, further analysis showed that despite interference in many components of programming, with some exceptions, the COVID-19 pandemic generally did not diminish government commitment to FP and programs remained resilient in providing access to services. Common themes mentioned by 178 respondents (18.5% of respondents) included: fear of infection; disruption of services / difficulty with lockdown and travel restrictions; staff / facilities diverted to COVID-19; access to reproductive health services and contraceptive methods affected; shifts in services / outreach; interference with logistics & supplies, training & supervision, and M&E; lack of attention to FP/sexual reproductive health; financing reduced or diverted; and effects on existing partnerships. A strong enabling environment for FP, which the NCIFP is designed to measure, was positively correlated with continued government commitment and access to contraceptive methods during COVID-19. Conclusion These findings are instructive for programming: it will face challenges and 'interference' when unanticipated shocks like COVID-19 occur, with strong FP programs best prepared to exhibit resilience.
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Affiliation(s)
| | | | - John Ross
- Independent demographic consultant, New Paltz, NY, 12561, USA
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Abdel Tawab N, Tayel SA, Radwan SM, Ramy MA. The effects of COVID-19 pandemic on women's access to maternal health and family planning services in Egypt: an exploratory study in two governorates. BMC Health Serv Res 2024; 24:267. [PMID: 38431588 PMCID: PMC10909277 DOI: 10.1186/s12913-023-10531-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 12/27/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has been noted to decrease access to maternal health and family planning services globally. However, evidence from the Middle East and North Africa region is very scarce and limited. We qualitatively explored women's experiences in accessing maternal health and family planning services during the COVID-19 lockdown months in the two Egyptian governorates of Port Said and Souhag. METHODS Using a case study design, semi-structured phone interviews were conducted with a total of 40 women aged 18-35 years from Port Said and Souhag governorates in Egypt. Interviews explored women's experiences in accessing maternal health and family planning services during COVID-19 lockdown months, their coping strategies, and impact of challenges and/or coping strategies on participants and their families. The collected data was analyzed manually using qualitative thematic analysis. RESULTS Many participants were unable to access maternal health and family planning services during COVID-19 lockdown due to fear of contracting the virus, closure of health facilities, changing service hours, family planning method or drug stock-outs, and/or financial constraints. The above challenges in accessing services along with coping strategies that some women and their families used exposed women to additional health risks, including unintended pregnancies, and posed several social, emotional, and financial burdens to many. CONCLUSIONS The COVID-19 pandemic and associated lockdown measures undermined women's access to maternal and family planning services and interfered with their ability to achieve their reproductive goals. The paper concludes with a number of recommendations to ensure access to maternal and family planning services at times of crisis. Those recommendations include: (1) adapting reliable guidelines from humanitarian settings, (2) providing adequate guidance to healthcare providers and the public to tackle fears and misinformation, (3) making self-care products available such as oral contraceptive pills, vaginal rings and self- administered injectables, (4) involving other health professionals in the provision of maternal and family planning services through task-sharing/shifting, (5) expanding the use of telemedicine and/or digital health services especially to those living in remote areas and (6) raising policymakers' awareness of the centrality of reproductive rights and the importance of protecting them at all times.
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Affiliation(s)
| | - Salma A Tayel
- Bill and Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Mohamed A Ramy
- United Nations Development Programme, Geneva, Switzerland
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Karp C, Williams K, Wood SN, OlaOlorun FM, Akilimali P, Guiella G, Gichangi P, Mosso R, Makumbi F, Anglewicz PA, Moreau C. Family planning service disruptions in the first two years of the COVID-19 pandemic: Evidence from health facilities in seven low- and middle-income countries. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002435. [PMID: 38180911 PMCID: PMC10769091 DOI: 10.1371/journal.pgph.0002435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/16/2023] [Indexed: 01/07/2024]
Abstract
Many speculated that COVID-19 would severely restrict the delivery of essential health services, including family planning (FP), but evidence of this impact is limited, partly due to data limitations. We use cross-sectional data collected from regional and national samples of health facilities (n = 2,610) offering FP across seven low- and middle-income countries (LMICs) between 2019 and 2021, with longitudinal data from four geographies, to examine reported disruptions to the FP service environment during COVID-19, assess how these disruptions varied according to health system characteristics, and evaluate how disruptions evolved throughout the first two years of the pandemic, relative to a pre-pandemic period. Findings show significant variation in the impact of COVID-19 on facility-based FP services across LMICs, with the largest disruptions to services occurring in Rajasthan, India, where COVID-19 cases were highest among geographies sampled, while in most sub-Saharan African settings there were limited disruptions impacting FP service availability, method provision, and contraceptive supplies. Facility-reported disruptions to care were not reflected in observed changes to the number of FP clients or types of stockouts experienced in the first two years of the pandemic. Public and higher-level facilities were generally less likely to experience COVID-19-related disruptions to FP services, suggesting policy mitigation measures-particularly those implemented among government-operated health facilities-may have been critical to ensuring sustained delivery of reproductive healthcare during the pandemic.
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Affiliation(s)
- Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kelsey Williams
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Shannon N. Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Funmilola M. OlaOlorun
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Pierre Akilimali
- Patrick Kayembe Research Center, Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population (ISSP/University Joseph Ki-Zerbo), Ouagadougou, Burkina Faso
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
- Department of Primary Care, Technical University of Mombasa, Ghent University, Ghent, Belgium
| | - Rosine Mosso
- École Nationale Supérieure de Statistique et d’Economie Appliquee (ENSEA) of Abidjan, Abidjan, Côte d’Ivoire
| | | | - Philip A. Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Soins et Santé Primaire, CESP Centre for Research in Epidemiology and Population Health U1018, Inserm, Villejuif, France
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Felker-Kantor E, Aung YK, Wheeler J, Keller B, Paudel M, Little K, Thein ST. Contraceptive method switching and discontinuation during the COVID-19 pandemic in Myanmar: findings from a longitudinal cohort study. Sex Reprod Health Matters 2023; 31:2215568. [PMID: 37335341 PMCID: PMC10281389 DOI: 10.1080/26410397.2023.2215568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
The objective of this paper was to document contraceptive dynamics and associated correlates of contraceptive method switching and discontinuation in Myanmar during the COVID-19 pandemic. We conducted a secondary analysis of panel data collected between August 2020 and March 2021 among married women of reproductive age of households registered for a strategic purchasing project in Yangon. Statistical analysis included descriptive statistics, bivariate tests of association and adjusted log-Poisson models with generalised estimating equations to examine relative risks and 95% confidence intervals. Among the study sample, 28% of women reported method switching and 20% method discontinuation at least once during the study period. Difficulties accessing resupply/removal/insertion of contraception due to COVID-19 and method type at baseline were identified as correlates of method switching and discontinuation. Women who reported difficulty obtaining their method due to COVID-19 had an increased risk of method switching (RRadj: 1.85, 95%CI: 1.27, 2.71). Women who reported injectables as their initial contraceptive method at baseline had an increased risk of method switching (RRadj:1.71, 95%CI: 1.06, 2.76) and method discontinuation (RRadj: 2.16, 95%CI: 1.16, 4.02) compared to non-injectable users. As Myanmar evaluates its public health response to COVID-19, the country should consider innovative service delivery models that allow women to have sustained access to their method of choice during a health emergency. (211).
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Affiliation(s)
- Erica Felker-Kantor
- Faculty, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA; Senior Research Advisor, Population Services International, Washington, DC, USA
| | - Ye Kyaw Aung
- Senior Research Manager, Population Services International Myanmar, Yangon, Myanmar
| | - Jenny Wheeler
- Head of Strategic Research and Learning, Population Services International, Washington, DC, USA
| | - Brett Keller
- Senior Research Advisor, Population Services International, Washington, DC, USA
| | - Mahesh Paudel
- Research Advisor, Population Services International, Kathmandu, Nepal
| | - Kristen Little
- Senior Technical Advisor for Strategic Research, Population Services International, Washington, DC, USA
| | - Si Thu Thein
- Deputy Country Director, Population Services International Myanmar, Yangon, Myanmar
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Yesuf EA, Abdisa B, Sime H, Alemu EK, Asseffa NA, Jisso M, Tamiso A, Alemayehu A, Fikre R, Umer A, Kebede M, Mohammed H, Yazie B, Gurmu KK, Gashu KD, Angaw DA, Endehabtu BF, Tilahun B, Gonete TZ. Essential Health Services Delivery Status During COVID-19 Pandemic in Ethiopia: A National Mixed-Methods Survey of Primary Healthcare Units. Ethiop J Health Sci 2023; 33:87-94. [PMID: 38352668 PMCID: PMC10859741 DOI: 10.4314/ejhs.v33i2.2s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/09/2023] [Indexed: 02/16/2024] Open
Abstract
Background Essential health services are a package of services critical to improve health outcomes. COVID-19 pandemic disrupts essential health services. However, the level of essential health service disruption due to COVID-19 in Ethiopia is not clear. This study aimed at measuring the status of delivery of essential health services in Ethiopia during COVID-19. Methods A national mixed-methods cross-sectional survey was conducted. It was undertaken in Amhara (10 districts), Oromia (eight districts), Sidama (six districts), Southern Nations, Nationalities, and People's Region (16 districts), and Dire Dawa City Administration. A total of 452 health facilities were surveyed. Data were collected using face-to-face interview. Descriptive analysis was undertaken. Qualitative data was analyzed thematically. Results The woredas (districts) and health facilities which adopted essential health services before the COVID-19 pandemic were 81.4% and 51.2%, respectively. Nearly all health centers provided antenatal care services. Blood pressure measuring apparatus and delivery set were available in all health centers. However, only 50% of health centers had radiant warmer. Malnutrition services were provided by 47% of rural health centers. Moreover, a functional incinerator was available in only 41% of health centers. The provision of cardiovascular disease management was at 27.2%. Furthermore, HIV/AIDS treatment was provided by 43.5% of health facilities. Conclusion The adoption of lists of essential health services was optimal. The status of delivery of essential health services was high for maternal healthcare. Neonatal care at birth, malnutrition treatment, and cardiovascular disease management were low. The district health system should strive more to maintain essential health services.
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Affiliation(s)
| | - Biru Abdisa
- Jimma University, Institute of Health, Ethiopia
| | | | | | | | - Meskerem Jisso
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | - Alemu Tamiso
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | | | - Rekiku Fikre
- Hawassa University, College of Medicine and Health Sciences, Ethiopia
| | - Abdurezak Umer
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Mesfin Kebede
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Hussen Mohammed
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Bekele Yazie
- Dire Dawa University, College of Medicine and Health Sciences, Ethiopia
| | - Kassu Ketema Gurmu
- World Health Organization Country Office for Ethiopia, Universal Health Coverage/Life Course, Health System Strengthening Team, Addis Ababa, Ethiopia
| | - Kassahun Dessie Gashu
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
| | - Dessies Abebaw Angaw
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
| | | | - Binyam Tilahun
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
| | - Tajebew Zayede Gonete
- University of Gonder, College of Medicine and Health Science, Institute of Public Health, Ethiopia
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Rezaei F, Amiri-Farahani L, Haghani S, Pezaro S, Behmanesh F. The impact of the COVID-19 pandemic on contraceptive methods, abortion, and unintended pregnancy: a cross-sectional study. BMC Womens Health 2023; 23:357. [PMID: 37403093 DOI: 10.1186/s12905-023-02512-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND AND AIM By creating an international emergency, the COVID-19 pandemic may have led to compromised reproductive health care, including family planning services, and thus increased unintended pregnancies and unsafe abortions. This study was conducted to compare methods of contraception, abortion, and unintended pregnancies in those served by the health centers of Babol city in Iran, both before and during the COVID-19 pandemic. METHODS A cross-sectional study was conducted including 425 participants registered to the health centers of Babol city, Mazandaran province, Iran. Using a multi-stage method, 6 urban health centers and 10 rural centers were selected for inclusion. Proportional allocation method was used for sampling those who met the inclusion criteria. A questionnaire was used to collect data in relation to individual characteristics and reproductive behaviors via 6 questions focused upon methods and preparation of contraception, number and type of abortions, and number and causes of unintended pregnancy from July to November 2021. The data were analyzed using SPSS software version 26. Significance level was considered to be p < 0.05 in all tests. RESULTS Most participants aged between 20 and 29 years old had a diploma level of education, were housewives and lived in the city. Prior to the pandemic, 32.0% used modern contraceptive methods and 31.6% used these during the pandemic. No change in the combination of contraceptive methods used was observed between these two periods. Approximately two-thirds used the withdrawal method in both periods. The majority of participants in both periods purchased their contraceptives from a pharmacy. Unintended pregnancy increased from 20.4% prior to the pandemic to 25.4% during the pandemic. Abortions increased from 19.1% prior to the pandemic to 20.9% during the pandemic, although these findings were not found to be statistically significant. Contraceptive methods had a statistically significant relationship with age, education, spouse's education, spouse's occupation, and place of residence. The number of unintended pregnancies had a significant relationship with age, the educational level of both participants and their spouses and socio-economic status, and the number of abortions had a statistically significant relationship with the age and education level of the spouse (p > 0.05). CONCLUSION Despite there being no change in contraceptive methods compared to the pre-pandemic period, an increase in the number of unintended pregnancies, abortions and illegal abortions was observed. This may be indicative of an unmet need for family planning services during the COVID-19 pandemic.
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Affiliation(s)
- Fatemeh Rezaei
- MSc in Midwifery, Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amiri-Farahani
- Department of Reproductive Health and Midwifery, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Shima Haghani
- Department of Biostatistics, Nursing and Midwifery Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sally Pezaro
- PhD in Midwifery, The Research Centre for Healthcare and Communities, Coventry University, Coventry, UK
- The University of Notre Dame, Fremantle, Australia
| | - Fereshteh Behmanesh
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Chiu C, Wong A, Melvin O, Vernon J, Liu JX, McCoy SI, Packel LJ. Effects of the COVID-19 pandemic on sales of sexual and reproductive health products: an ecological study of pharmacies in Kenya. BMJ Open 2023; 13:e068222. [PMID: 37385741 PMCID: PMC10314534 DOI: 10.1136/bmjopen-2022-068222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 06/14/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVES To examine how sales of sexual and reproductive health (SRH) products varied among pharmacies in Kenya using administrative data, leveraging natural variation in the COVID-19 pandemic and accompanying policy restrictions between 2019 and 2021. DESIGN AND SETTING Ecological study of pharmacies in Kenya. PARTICIPANTS 761 pharmacies using the Maisha Meds product inventory management system (capturing 572 916 products sold). OUTCOMES Sales quantity, price and revenue of SRH products sold per pharmacy per week. RESULTS COVID-19 deaths were associated with a -2.97% (95% CI -3.82%, -2.11%) decrease in sales quantity, a 1.09% (95% CI 0.44%, 1.72%) increase in sales price and a -1.89% (-1.00%, -2.79%) decrease in revenues per pharmacy per week. Results were similar when considering new COVID-19 cases (per 1000) and the Average Policy Stringency Index. Results differed substantially between individual SRH products-a large decrease in sales quantity in pregnancy tests, injectables and emergency contraception, a modest decrease in condoms and no change in oral contraception. Sales price increases were similarly varied; four of the five most sold products were revenue neutral. CONCLUSIONS We found a robust negative association between SRH sales at pharmacies in Kenya and COVID-19 reported cases, deaths and policy restriction. Although our data cannot definitively point to reduced access, existing evidence from Kenya regarding unchanged fertility intentions, increases in unintended pregnancies and reported reasons for non-use of contraceptives during COVID-19 suggests a prominent role of reduced access. While policymakers may have a role in sustaining access, their role may be limited by broader macroeconomic problems, such as global supply chain disruptions and inflation, during supply shocks.
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Affiliation(s)
- Calvin Chiu
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Anne Wong
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | | | | | - Jenny X Liu
- School of Nursing, University of California San Francisco, San Francisco, California, USA
- Institute for Health and Aging, Bixby Center for Global Reproductive Health, University of California San Francisco, San Francisco, California, USA
| | - Sandra I McCoy
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Laura J Packel
- School of Public Health, University of California Berkeley, Berkeley, California, USA
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Bolarinwa OA, Odimegwu C, Okeke SR, Ajayi KV, Sah RK. Barriers and facilitators to accessing and using sexual and reproductive health services during the COVID-19 pandemic outbreak in Africa: a protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e071753. [PMID: 37369424 PMCID: PMC10410933 DOI: 10.1136/bmjopen-2023-071753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Access and utilisation of sexual and reproductive health services remain an important component in averting adverse sexual and reproductive health outcomes. However, the unprecedented emergence of the 2019 coronavirus disease (COVID-19) left most of these services disrupted in Africa. Thus, this protocol study seeks to conduct a systematic review and meta-analysis of barriers and facilitators to accessing and using sexual and reproductive health services during the COVID-19 pandemic outbreak in Africa. METHOD AND ANALYSIS An open electronic database search will be conducted in African journals online, PubMed, CINAHL, EMBASE and PsycINFO to identify potentially eligible studies published between January 2020 and December 2022. Two authors from the research team will screen the title and abstract of the potential studies, and another two authors will independently assess the full articles based on the inclusion or exclusion criteria. Studies will be selected if they examine barriers and facilitators to accessing and using sexual and reproductive health services, including family planning counselling and services, sexually transmitted infections (STIs)/HIV testing, consultation, and treatment, and provision of abortion services during the COVID-19 pandemic outbreak in Africa. The data extracted from the included studies will be analysed using Review Manager (RevMan V.5) and Meta-Analysis software V.3. Each outcome measure will be analysed separately against barriers and facilitators; the dichotomous data will be presented in odd ratios with a 95% CI, while mean and standardised mean differences will be employed to present the continuous data. We envisage that the potential results of this study will identify the barriers and facilitators to family planning counselling and services, STIs/HIV testing, consultation, and treatment, and provision of abortion services during the COVID-19 pandemic outbreak in Africa, which can be used to develop required interventions and policies to curb identified barriers. ETHICS AND DISSEMINATION Ethical approval is not required for a systematic review and meta-analysis. Findings from this study will be disseminated through conferences and peer-reviewed publication. PROSPERO REGISTRATION NUMBER CRD42022373335.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Public Health, York St John University, London, UK
| | - Clifford Odimegwu
- Demography, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Sylvester R Okeke
- Centre for Social Research in Health, UNSW, Sydney, New South Wales, Australia
| | - Kobi V Ajayi
- Department of Health Behavior, Texas A&M University System, College Station, Texas, USA
| | - Rajeeb Kumar Sah
- Department of Public Health, University of Huddersfield, Huddersfield, UK
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13
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Wood SN, Byrne ME, Thiongo M, Devoto B, Wamue-Ngare G, Decker MR, Gichangi P. Fertility and contraceptive dynamics amidst COVID-19: who is at greatest risk for unintended pregnancy among a cohort of adolescents and young adults in Nairobi, Kenya? BMJ Open 2023; 13:e068689. [PMID: 37130679 PMCID: PMC10163330 DOI: 10.1136/bmjopen-2022-068689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Among youth in Nairobi, we (1) characterised fertility and contraceptive use dynamics by gender; (2) estimated pregnancy prevalence over the pandemic; and (3) assessed factors associated with unintended pandemic pregnancy for young women. DESIGN Longitudinal analyses use cohort data collected at three timepoints prior to and during the COVID-19 pandemic: June to August 2019 (pre-pandemic), August to October 2020 (12-month follow-up) and April to May 2021 (18-month follow-up). SETTING Nairobi, Kenya. PARTICIPANTS At initial cohort recruitment, eligible youth were aged 15-24 years, unmarried and residing in Nairobi for at least 1 year. Within-timepoint analyses were restricted to participants with survey data per round; trend and prospective analyses were restricted to those with complete data at all three timepoints (n=586 young men, n=589 young women). PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes comprised fertility and contraceptive use for both genders, and pregnancy for young women. Unintended pandemic pregnancy (assessed at 18-month follow-up) was defined as a current or past 6-month pregnancy with intent to delay pregnancy for more than 1 year at 2020 survey. RESULTS While fertility intentions remained stable, contraceptive dynamics varied by gender-young men both adopted and discontinued coital-dependent methods, whereas young women adopted coital-dependent or short-acting methods at 12-month follow-up (2020). Current pregnancy was highest at 2020 (4.8%), and approximately 2% at 2019 and 2021. Unintended pandemic pregnancy prevalence was 6.1%, with increased odds for young women recently married (adjusted OR (aOR)=3.79; 95% confidence interval (CI) 1.83-7.86); recent contraceptive use was protective against unintended pandemic pregnancy (aOR=0.23; 95% CI 0.11-0.47). CONCLUSIONS Current pregnancy in Nairobi was highest at the height of the COVID-19 pandemic (2020), and subsided to pre-pandemic levels by 2021 data collection; however, requires further monitoring. New marriages posed considerable risk for unintended pandemic pregnancy. Contraceptive use remains a crucial preventive strategy to averting unintended pregnancy, particularly for married young women.
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Affiliation(s)
- Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Meagan E Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Thiongo
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
| | - Bianca Devoto
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Grace Wamue-Ngare
- Department of Sociology, Gender and Development Studies, Kenyatta University, Nairobi, Kenya
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter Gichangi
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
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14
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Callahan RL, Cartwright AF, Beksinska M, Kasaro M, Tang JH, Milford C, Wong C, Velarde M, Maphumulo V, Fawzy M, Chinyama M, Chabu E, Mudenda M, Smit J. Impact of the COVID-19 pandemic on women's contraceptive use: a mixed-methods study in South Africa and Zambia. Gates Open Res 2023; 7:61. [PMID: 39086400 PMCID: PMC11290906 DOI: 10.12688/gatesopenres.14590.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 08/02/2024] Open
Abstract
Background: The COVID-19 pandemic affected global access to health services, including contraception. We sought to explore effects of the pandemic on family planning (FP) service provision and use in South Africa and Zambia, including on implant and intrauterine device (IUD) users' desire and ability to obtain removal. Methods: Between August 2020 and April 2021, we conducted surveys with 537 women participating in an ongoing longitudinal contraceptive continuation study. We also carried out in-depth interviews with 39 of the survey participants and 36 key informants involved in FP provision. We conducted descriptive analysis of survey responses and thematic analysis of interviews. Results: Contraceptive use changed minimally in this sample with the emergence of COVID-19. Fewer than half of women (n=220) reported attempting to access FP since the start of the pandemic, the vast majority of whom were using short-acting methods. Among those who sought services, 95% obtained their preferred method. The proportion of women not using a method before and after pandemic start did not change in Zambia (31%); in South Africa, the proportion increased from 8% to 10%. Less than 7% of implant or IUD users in either country reported wanting removal. Among those who sought removal (n=22), 91% (n=10) in Zambia and 55% (n=6) in South Africa successfully obtained removal. In qualitative interviews, women with challenges accessing FP services mentioned long queues, deprioritization of contraceptive services, lack of transportation, stock-outs, and fear of contracting COVID-19 at a facility. Key informants reported stock-outs, especially of injectables, and staff shortages as barriers. Conclusions: We did not find a substantial impact of COVID-19 on contraceptive access among this sample; however, providers and others involved in service provision identified risks to continuity of care. As the COVID-19 pandemic wanes, it continues to be important to monitor people's ability to access their preferred contraceptive methods.
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Affiliation(s)
| | | | - Mags Beksinska
- MatCH Research Unit (MRU), Department of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
| | - Margaret Kasaro
- Division of Global Women’s Health, Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer H. Tang
- Division of Global Women’s Health, Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cecilia Milford
- MatCH Research Unit (MRU), Department of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
| | | | | | - Virginia Maphumulo
- MatCH Research Unit (MRU), Department of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
| | | | | | | | | | - Jennifer Smit
- MatCH Research Unit (MRU), Department of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa
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15
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Chekol BM, Muluye S, Sheehy G. Impacts of COVID-19 on reproductive health service provision, access, and utilization in Ethiopia: Results from a qualitative study with service users, providers, and stakeholders. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001735. [PMID: 36963081 PMCID: PMC10035746 DOI: 10.1371/journal.pgph.0001735] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/28/2023] [Indexed: 03/25/2023]
Abstract
Ethiopia has made significant improvements to sexual and reproductive health (SRH) in recent decades, yet the COVID-19 pandemic brought new challenges to SRH service delivery. In the early months of the pandemic, health facility and health management information system data showed reductions in SRH service utilization, however more evidence is needed on ongoing SRH impacts to inform policy and program decision-making. Our study aimed to assess the impacts of COVID-19 on SRH service utilization and access from the perspective of providers, clients, and stakeholders in Addis Ababa and Amhara Regional State. We collected data from May through July 2021 via six focus group discussions with health service providers, 50 in-depth interviews with SRH service clients and 15 key informant interviews with policy and programmatic stakeholders. All audio recordings were transcribed and translated from Amharic into English. Data were coded and analyzed for content and themes using Excel and NVivo 10. We found that COVID-19 and associated public health mitigation measures had consequences on SRH prioritization, funding, and service delivery. Efforts to halt the spread of COVID-19, such as gathering and transportation restrictions, also reduced access to SRH services. Fear of infection, costly and inaccessible transportation, commodity stockouts, and limited service availability all impeded access to and use of SRH services. For some women, this meant losing timely access to contraception and subsequently facing unwanted pregnancies. Providers experienced increased workloads, anxiety, and stigma as possible sources of infection. Our findings offer useful learnings for program and policy stakeholders aiming to meet SRH needs during the pandemic, and during times of crisis more broadly.
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Affiliation(s)
| | | | - Grace Sheehy
- Ipas, Chapel Hill, NC, United States of America
- * E-mail:
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16
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Ensor S, Mechie I, Ryan R, Mussa A, Bame B, Tamuthiba L, Moshashane N, Morroni C. Measuring the impact of COVID-19 social distancing measures on sexual health behaviours and access to HIV and sexual and reproductive health services for people living with HIV in Botswana. Front Glob Womens Health 2023; 4:981478. [PMID: 36970120 PMCID: PMC10030995 DOI: 10.3389/fgwh.2023.981478] [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: 06/29/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
Introduction Uninterrupted access to HIV and sexual and reproductive health (SRH) services is essential, particularly in high HIV prevalence settings, to prevent unintended pregnancy and vertical HIV transmission. Understanding the challenges that COVID-19 and associated social distancing measures (SDMs) posed on health service access is imperative for future planning. Methods This cross-sectional study was conducted in Botswana between January-February 2021. A web-based questionnaire was disseminated on social media as part of the International Sexual Health and REproductive Health (I-SHARE) Survey. Respondents answered questions on SRH, before and during COVID-19 SDMs. Subgroup analysis and comparison of descriptive data was performed for people living with HIV (PLWH). Results Of 409 participants, 65 were PLWH (80% female, 20% male). During SDMs, PLWH found it more difficult to access condoms and treatment for HIV and STIs; attend HIV appointments; and maintain adherence to antiretroviral therapy. Compared to HIV-negative women, a higher proportion of women living with HIV used condoms as their primary method of contraception (54% vs. 48%), and had lower use of long-acting reversible contraception (8% vs. 14%) and dual contraception (8% vs. 16%). Discussion Mirroring global trends, COVID-19 disrupted HIV and SRH service access in Botswana. However, in high HIV-prevalence settings, disruption may more severely impact population health with disproportionate effects on women. Integration of HIV and SRH services could build health system capacity and resilience, reduce missed opportunities for delivering SRH services to PLWH and limit the consequences of future restrictions that may cause health system disruption.
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Affiliation(s)
- Samuel Ensor
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Imogen Mechie
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Rebecca Ryan
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Aamirah Mussa
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Bame Bame
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Lefhela Tamuthiba
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Neo Moshashane
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Chelsea Morroni
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- MRC Centre for Reproductive Health and Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
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17
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Safdari-Dehcheshmeh F, Noroozi M, Memar S, Taleghani F. Childbearing decisions and related factors in the COVID-19 pandemic: A narrative review study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:48. [PMID: 37113433 PMCID: PMC10127467 DOI: 10.4103/jehp.jehp_594_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/06/2022] [Indexed: 06/19/2023]
Abstract
The COVID-19 pandemic has had considerable consequences in many areas of life, including the social area and childbearing plans. The present narrative review aimed to examine the childbearing decisions and its related factors during the COVID-19 pandemic. This review was conducted by searching in scientific databases, including Web of Science, Science Direct, Google Scholar, Scopus, Cochrane, PubMed, ProQuest, Scientific Information Database (SID), Iranian Research Institute for Information Science and Technology (IranDoc) and Iranian Journal Database (Magiran) in June 2022. The search resulted in 111 sources, of which 16 were in line with the research objective. Couples have mainly cancelled or delayed their previous plans related to childbearing decisions. There are two groups of direct and indirect factors related to childbearing decisions during the COVID-19 pandemic: The former includes (1) well-being-related factors such as economic conditions, interpersonal relationships and gender roles in terms of task division; and (2) health-related factors, including health emergencies and physical and psychological health. The latter includes factors such as social distancing and social media. Based on the results, governments should facilitate childbearing by adjusting existing policies, addressing economic insecurity and protecting the livelihoods of those affected by the crisis. Health policymakers and planners must also prioritize women's access to reproductive health services in a safe environment while promoting equity in access. It is also necessary to promote the quality and quantity of indirect care and virtual counseling based on the needs of women in crisis.
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Affiliation(s)
- Faranak Safdari-Dehcheshmeh
- Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mahnaz Noroozi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Soraya Memar
- Department of Social Sciences, Isfahan University, Isfahan, Iran
| | - Fariba Taleghani
- Department of Adult Health Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Sileo KM, Muhumuza C, Helal T, Olfers A, Lule H, Sekamatte S, Kershaw TS, Wanyenze RK, Kiene SM. Exploring the effects of COVID-19 on family planning: results from a qualitative study in rural Uganda following COVID-19 lockdown. Reprod Health 2023; 20:31. [PMID: 36759838 PMCID: PMC9910252 DOI: 10.1186/s12978-023-01566-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/06/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has likely affected the already high unmet need for family planning in low- and middle-income countries. This qualitative study used Andersen's Behavioral Model of Health Service Use as a theoretical framework to explore the possible ways in which the COVID-19 pandemic, including the impact of a 3-month government mandated lockdown, might affect family planning outcomes in rural Uganda. A secondary aim was to elicit recommendations to improve family planning service delivery in the context of COVID-19. METHODS Between June and October 2020, we conducted four focus group discussions with men and women separately (N = 26) who had an unmet need for family planning, and 15 key-informant interviews with community leaders and family planning stakeholders. Data were analyzed using thematic analysis. RESULTS We identified a significant disruption to the delivery of family planning services due to COVID-19, with potential negative effects on contraceptive use and risk for unintended pregnancy. COVID-19 had a negative effect on individual enabling factors such as family income, affecting service access, and on community enabling factors, such as transportation barriers and the disruption of community-based family planning delivery through village health teams and mobile clinics. Participants felt COVID-19 lockdown restrictions exacerbated existing contextual predisposing factors related to poverty and gender inequity, such as intimate partner violence and power inequities that diminish women's ability to refuse sex with their husband and their autonomy to use contraceptives. Recommendations to improve family planning service delivery in the context of COVID-19 centered on emergency preparedness, strengthening community health systems, and creating new ways to safely deliver contractive methods directly to communities during future COVID-19 lockdowns. CONCLUSIONS This study highlights the consequences of COVID-19 lockdown on family planning distribution, as well as the exacerbation of gender inequities that limit women's autonomy in pregnancy prevention measures. To improve family planning service uptake in the context of COVID-19, there is a need to strengthen emergency preparedness and response, utilize community structures for contraceptive delivery, and address the underlying gender inequities that affect care seeking and service utilization.
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Affiliation(s)
- Katelyn M. Sileo
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX USA
| | | | - Teddy Helal
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX USA
| | - Allison Olfers
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX USA
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Tumlinson K, Britton LE, Goland E, Chung S, Bullington BW, Williams CR, Wambua DM, Onyango DO, Senderowicz L. Contraceptive stockouts in Western Kenya: a mixed-methods mystery client study. BMC Health Serv Res 2023; 23:74. [PMID: 36694177 PMCID: PMC9872072 DOI: 10.1186/s12913-023-09047-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The prevalence of modern contraception use is higher in Kenya than in most countries in Sub-Saharan Africa. The uptake has however slowed down in recent years, which, among other factors, has been attributed to challenges in the supply chain and increasing stockouts of family planning commodities. Research on the frequency of contraceptive stockouts and its consequences for women in Kenya is still limited and mainly based on facility audits. METHODS This study employs a set of methods that includes mystery clients, focus group discussions, key informant interviews, and journey mapping workshops. Using this multi-method approach, we aim to quantify the frequency of method denial resulting from contraceptive stockout and describe the impact of stockouts on the lived experiences of women seeking contraception in Western Kenya. RESULTS Contraceptives were found to be out of stock in 19% of visits made to health facilities by mystery clients, with all contraceptive methods stocked out in 9% of visits. Women experienced stockouts as a sizeable barrier to accessing their preferred method of contraception and a reason for taking up non-preferred methods, which has dire consequences for heath, autonomy, and the ability to prevent unintended pregnancy. Reasons for contraceptive stockouts are many and complex, and often linked to challenges in the supply chain - including inefficient planning, procurement, and distribution of family planning commodities. CONCLUSIONS Contraceptive stockouts are frequent and negatively impact patients, providers, and communities. Based on the findings of this study, the authors identify areas where funding and sustained action have the potential to ameliorate the frequency and severity of contraceptive stockouts, including more regular deliveries, in-person data collection, and use of data for forecasting, and point to areas where further research is needed.
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Affiliation(s)
- Katherine Tumlinson
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | - Emilia Goland
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA.
| | - Stephanie Chung
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA
| | - Brooke W Bullington
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Caitlin R Williams
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA
- Department of Mother and Child Health, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Dickens Otieno Onyango
- Kisumu County Department of Health, Kisumu, Kenya
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | - Leigh Senderowicz
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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20
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Moreau C, Karp C, Wood S, Williams K, Olaolorun FM, Akilimali P, Guiella G, Gichangi P, Zimmerman L, Anglewicz P. Trends in fertility intentions and contraceptive practices in the context of COVID-19 in sub-Saharan Africa: insights from four national and regional population-based cohorts. BMJ Open 2023; 13:e062385. [PMID: 36657770 PMCID: PMC9852736 DOI: 10.1136/bmjopen-2022-062385] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Studies in several sub-Saharan geographies conducted early in the COVID-19 pandemic suggested little impact on contraceptive behaviours. Initial results may mask widening disparities with rising poverty, and changes to women's pregnancy desires and contraceptive use amid prolonged health service disruptions. This study examined trends in contraceptive behaviours in four sub-Saharan African settings 1 year into the pandemic. DESIGN Nationally and regionally representative longitudinal surveys. SETTING Burkina Faso, Kenya, Democratic Republic of Congo (Kinshasa) and Nigeria (Lagos). PARTICIPANTS Women aged 15-49 years with sample size ranging from 1469 in Nigeria to 9477 in Kenya. OUTCOME MEASURES Fertility preferences, contraceptive use and unintended pregnancies measured before COVID-19 (November 2019 to January 2020) and during COVID-19 (November 2020 to January 2021). ANALYSIS We described population-level and individual-level changes by socioeconomic characteristics using generalised equation modelling. We used logistic regression models to identify factors related to contraceptive adoption and discontinuation and to experiencing an unintended pregnancy. RESULTS At the population level, we found no change in women's exposure to unintended pregnancy risk, alongside 5-9 percentage point increases in contraceptive prevalence in Burkina Faso, Kenya and Lagos. Reliance on provider-dependent methods dropped by 2 and 4 percentage points in Kenya and Burkina Faso, respectively, although these declines were not statistically significant. Between 1.0% and 2.8% of women across sites experienced an unintended pregnancy during COVID-19, with no significant change over time. Individual-level trajectories showed contraceptive adoption was more common than discontinuation in Burkina Faso, Kenya and Lagos, with little difference by sociodemographic characteristics. Women's COVID-19-related economic vulnerability was unrelated to unintended pregnancy across sites. CONCLUSIONS This study highlights the resilience of African women across diverse settings in sustaining contraceptive practices amid the COVID-19 pandemic. However, with reports of rising poverty in sub-Saharan Africa, there is continued need to monitor access to essential sexual and reproductive health services.
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Affiliation(s)
- Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Soins et Santé Primaire, Centre for Research in Epidemiology and Population Health (CESP) U1018, INSERM, Paris, France
| | - Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shannon Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kelsey Williams
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Pierre Akilimali
- School of Public Health, University of Kinshasa, Kinshasa, Republic of Congo
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Peter Gichangi
- International Centre for Reproductive Health, Mombasa, Kenya
| | - Linnea Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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21
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Otchere SA, Omunyidde S, Rosales A, Ochieng JA, Chebon L, Agordoh SW, Allison A. Faith Leaders Improve Healthy Timing and Spacing of Pregnancy: Results of Operations Research on the Channels of Hope Methodology in Kenya and Ghana. Ann Glob Health 2023; 89:19. [PMID: 36937332 PMCID: PMC10022531 DOI: 10.5334/aogh.3944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 01/15/2023] [Indexed: 03/18/2023] Open
Abstract
Background Family planning averts unintended pregnancies, unsafe abortions, and maternal deaths, while improving child health and socio-economic progress, but an estimated 218 million women and girls in low- and middle-income countries, especially in sub-Saharan Africa, have an unmet need for modern family planning. Faith leaders can impact the demand and uptake of family planning. However, there is limited understanding of the mechanisms for effective family planning advocacy by faith leaders. Channels of Hope (CoH) is World Vision's process that engages faith leaders and faith communities to address health issues. Objectives To determine the impact of CoH on promoting healthy timing and spacing of pregnancies and family planning (HTSP/FP) by mothers of children under two years old in select parts of Kenya and Ghana. To also determine faith leaders' attitudes, perceptions, and potential roles in influencing HTSP/FP after exposure to CoH. Methods A mixed methods operations research comprising quantitative (quasi-experimental design with surveys of 4,372 mothers of children under two years old) and qualitative arms (in-depth interviews of 17 faith leaders and their seven spouses) was implemented. Findings Taking both countries together, male sterilization, female condom, and LAM were the only FP methods that did not show increases from baseline to endline. Methods with the highest knowledge increases between intervention areas and control areas were implants, injectables and pills, with 18.4, 12.1 and 11.2 percentage point increases, respectively. The faith leaders in both countries reported that their views on healthy timing and spacing of pregnancies changed due to the Channels of Hope workshops. Conclusion The HTSP/FP model has potential for positive health and social transformation that is built on the trust of faith leaders. Ghana and Kenya provide great examples of possible scenarios in order to help prepare implementers to scale the learnings of this operations research across sub-Saharan Africa.
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Affiliation(s)
| | | | - Alfonso Rosales
- Formerly of World Vision, 300 “I” Street NE, Washington, DC 20002, US
- Epidemiology at Universidad Evangelica, El Salvador
- Columnist, El Mundo newspaper, El Salvador
| | - Jacob Ajwang Ochieng
- Formerly of World Vision Kenya, Karen Road, Off Ngong Rd. M/S, Nairobi, 254 Kenya
| | - Lilian Chebon
- World Vision Kenya, Karen Road, Off Ngong Rd. M/S, Nairobi, 254 Kenya
| | | | - Adrienne Allison
- Formerly of World Vision US, 300 “I” Street NE, Washington, DC, US
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22
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Polis CB, Biddlecom A, Singh S, Ushie BA, Rosman L, Saad A. Impacts of COVID-19 on contraceptive and abortion services in low- and middle-income countries: a scoping review. Sex Reprod Health Matters 2022; 30:2098557. [PMID: 35920612 PMCID: PMC9351554 DOI: 10.1080/26410397.2022.2098557] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
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.
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Affiliation(s)
- Chelsea B Polis
- Principal Research Scientist, Guttmacher Institute, New York, NY, USA
| | - Ann Biddlecom
- Director, International Research, Guttmacher Institute, New York, NY, USA. Correspondence: ; ; @annbiddlecom
| | - Susheela Singh
- Distinguished Scholar and Vice President, Global Science and Policy Integration, Guttmacher Institute, New York, NY, USA
| | - Boniface Ayanbekongshie Ushie
- Research Scientist, Sexual Reproductive Maternal Newborn Child and Adolescent Health, African Population and Health Research Center, Nairobi, Kenya
| | - Lori Rosman
- Lead Informationist, Welch Medical Library, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Abdulmumin Saad
- Deputy Editor-in-Chief, Global Health: Science and Practice Journal, Washington, DC, USA
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23
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Bonnet E, Beaugé Y, Ba MF, Sidibé S, De Allegri M, Ridde V. Knowledge of COVID-19 and the impact on indigents' access to healthcare in Burkina Faso. Int J Equity Health 2022; 21:150. [PMID: 36289543 PMCID: PMC9607810 DOI: 10.1186/s12939-022-01778-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/18/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND COVID-19 constitutes a global health emergency of unprecedented proportions. Preventive measures, however, have run up against certain difficulties in low and middle-income countries. This is the case in socially and geographically marginalized communities, which are excluded from information about preventive measures. This study contains a dual objective, i) to assess knowledge of COVID-19 and the preventive measures associated with it concerning indigents in the villages of Diebougou's district in Burkina Faso. The aim is to understand if determinants of this understanding exist, and ii) to describe how their pathways to healthcare changed from 2019 to 2020 during the COVID-19 pandemic. METHODS The study was conducted in the Diebougou healthcare district, in the south-west region of Burkina Faso. We relied on a cross-sectional design and used data from the fourth round of a panel survey conducted among a sample of ultra-poor people that had been monitored since 2015. Data were collected in August 2020 and included a total of 259 ultra-poor people. A multivariate logistic regression to determine the factors associated with the respondents' knowledge of COVID-19 was used. RESULTS Half of indigents in the district said they had heard about COVID-19. Only 29% knew what the symptoms of the disease were. The majority claimed that they protected themselves from the virus by using preventive measures. This level of knowledge of the disease can be observed with no differences between the villages. Half of the indigents who expressed themselves agreed with government measures except for the closure of markets. An increase of over 11% can be seen in indigents without the opportunity for getting healthcare compared with before the pandemic. CONCLUSIONS This research indicates that COVID-19 is partially known and that prevention measures are not universally understood. The study contributes to reducing the fragmentation of knowledge, in particular on vulnerable and marginalized populations. Results should be useful for future interventions for the control of epidemics that aim to leave no one behind.
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Affiliation(s)
- E. Bonnet
- grid.4399.70000000122879528Institut de Recherche Pour Le Développement, UMR 215 PRODIG, 5, Cours Des Humanités, 93 322 Aubervilliers Cedex, France
| | - Y. Beaugé
- grid.7700.00000 0001 2190 4373Heidelberg University, University Hospital and Medical Faculty, Heidelberg, Germany
| | - M. F. Ba
- grid.8191.10000 0001 2186 9619Institut de Santé Et de Développement (ISED), Cheikh Anta Diop University, Dakar, Senegal
| | - S. Sidibé
- University Joseph Ki-Zerbo of Ouagadougou, Ouagadougou, Burkina Faso
| | - M. De Allegri
- grid.7700.00000 0001 2190 4373Heidelberg University, University Hospital and Medical Faculty, Heidelberg, Germany
| | - V. Ridde
- grid.508487.60000 0004 7885 7602Institut de Recherche Pour Le Développement, Ceped, Université de Paris, Inserm ERL 1244, 45 Rue Des Saints-Pères, 75006 Paris, France ,grid.8191.10000 0001 2186 9619Institut de Santé Et Développement, Université Cheikh Anta Diop, Dakar, Senegal
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24
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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:e009594. [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] [MESH Headings] [Grants] [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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25
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Cartwright AF, Mackenzie ACL, Callahan RL, Bahamondes MV, Dorflinger LJ. IUD self-removal as self-care: Research is needed in low and middle-income countries. Front Glob Womens Health 2022; 3:992639. [PMID: 36159884 PMCID: PMC9490080 DOI: 10.3389/fgwh.2022.992639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alice F. Cartwright
- FHI 360, Durham, NC, United States
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- *Correspondence: Alice F. Cartwright
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26
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Brunie A, Austin G, Arkin J, Archie S, Amongin D, Ndejjo R, Acharya S, Thapa B, Brittingham S, McLain G, Mkandawire P, Doudou MH, Prata N. Women’s Experiences With Family Planning Under COVID-19: A Cross-Sectional, Interactive Voice Response Survey in Malawi, Nepal, Niger, and Uganda. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-22-00063. [PMID: 36041839 PMCID: PMC9426982 DOI: 10.9745/ghsp-d-22-00063] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/12/2022] [Indexed: 12/02/2022]
Abstract
Surveyed women attributed unintended pregnancies to COVID-19 and reported constraints to contraceptive access and use in Malawi, Nepal, Niger, and Uganda. Introduction: We conducted an assessment in Malawi, Nepal, Niger, and Uganda to document access-related reasons for not using contraceptive methods during the COVID-19 pandemic that led to unintended pregnancies, describe use of modern contraception among women in potential need of contraception compared to before the pandemic, examine method choice, and describe barriers to contraceptive access and use. Methods: Between December 2020 and May 2021, we conducted an opt-in phone survey with 21,692 women, followed by an outbound survey with 5,124 women who used modern nonpermanent contraceptive methods or who did not want to get pregnant within 2 years but were not using a modern contraceptive method. The surveys examined current behaviors and documented behaviors before the pandemic retrospectively. We used multivariable logistic regression models to examine factors associated with contraceptive use dynamics during COVID-19. Results: Pregnant women surveyed reported that the pandemic had affected their ability to delay or avoid getting pregnant, ranging from 27% in Nepal to 44% in Uganda. The percentage of respondents to the outbound survey using modern contraception decreased during the pandemic in all countries except Niger. Fear of COVID-19 infection was associated with discontinuing modern contraception in Malawi and with not adopting a modern method among nonusers in Niger. Over 79% of surveyed users were using their preferred method. Among nonusers who tried obtaining a method, reasons for nonuse included unavailability of the preferred method or of providers and lack of money; nonusers who wanted a method but did not try to obtain one cited fear of COVID-19 infection. Conclusion: We found evidence of surveyed women attributing unintended pregnancies to the pandemic and examples of constraints to contraceptive access and use on the supply and demand side. The effects of the pandemic must be interpreted within the local contraceptive, health system, and epidemiological context.
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Affiliation(s)
| | | | - Jamie Arkin
- Viamo, Nairobi, Kenya; Now with AInfluence Inc, Nairobi, Kenya
| | | | - Dinah Amongin
- Makerere University School of Public Health, Kampala, Uganda
| | - Rawlance Ndejjo
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | | | | | | | - Maimouna Hallidou Doudou
- Evidence for Sustainable Human Development Systems in Africa, and Université Africaine Privée pour le Développement, Niamey, Niger
| | - Ndola Prata
- Evidence for Sustainable Human Development Systems in Africa, University of California, Berkeley, CA, USA
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27
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Malkin M, Mickler AK, Ajibade TO, Coppola A, Demise E, Derera E, Ede JO, Gallagher M, Gumbo L, Jakopo Z, Little K, Mbinda A, Muchena G, Muhonde ND, Ncube K, Ogbondeminu FO, Pryor S, Sang EN. Adapting High Impact Practices in Family Planning During the COVID-19 Pandemic: Experiences From Kenya, Nigeria, and Zimbabwe. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-22-00064. [PMID: 36041833 PMCID: PMC9426984 DOI: 10.9745/ghsp-d-22-00064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/20/2022] [Indexed: 11/15/2022]
Affiliation(s)
| | - Alexandria K. Mickler
- U.S. Agency for International Development/Public Health Institute, Washington, DC, USA
| | | | | | - Eden Demise
- Population Services International, Washington, DC, USA
| | | | | | | | - Lucia Gumbo
- U.S. Agency for International Development, Harare, Zimbabwe
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28
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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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29
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Haakenstad A, Angelino O, Irvine CMS, Bhutta ZA, Bienhoff K, Bintz C, Causey K, Dirac MA, Fullman N, Gakidou E, Glucksman T, Hay SI, Henry NJ, Martopullo I, Mokdad AH, Mumford JE, Lim SS, Murray CJL, Lozano R. Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2022; 400:295-327. [PMID: 35871816 PMCID: PMC9304984 DOI: 10.1016/s0140-6736(22)00936-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Meeting the contraceptive needs of women of reproductive age is beneficial for the health of women and children, and the economic and social empowerment of women. Higher rates of contraceptive coverage have been linked to the availability of a more diverse range of contraceptive methods. We present estimates of the contraceptive prevalence rate (CPR), modern contraceptive prevalence rate (mCPR), demand satisfied, and the method of contraception used for both partnered and unpartnered women for 5-year age groups in 204 countries and territories between 1970 and 2019. METHODS We used 1162 population-based surveys capturing contraceptive use among women between 1970 and 2019, in which women of reproductive age (15-49 years) self-reported their, or their partner's, current use of contraception for family planning purposes. Spatiotemporal Gaussian process regression was used to generate estimates of the CPR, mCPR, demand satisfied, and method mix by age and marital status. We assessed how age-specific mCPR and demand satisfied changed with the Socio-demographic Index (SDI), a measure of social and economic development, using the meta-regression Bayesian, regularised, trimmed method from the Global Burden of Diseases, Injuries, and Risk Factors Study. FINDINGS In 2019, 162·9 million (95% uncertainty interval [UI] 155·6-170·2) women had unmet need for contraception, of whom 29·3% (27·9-30·6) resided in sub-Saharan Africa and 27·2% (24·4-30·3) resided in south Asia. Women aged 15-19 years (64·8% [62·9-66·7]) and 20-24 years (71·9% [68·9-74·2]) had the lowest rates of demand satisfied, with 43·2 million (95% UI 39·3-48·0) women aged 15-24 years with unmet need in 2019. The mCPR and demand satisfied among women aged 15-19 years were substantially lower than among women aged 20-49 years at SDI values below 60 (on a 0-100 scale), but began to equalise as SDI increased above 60. Between 1970 and 2019, the global mCPR increased by 20·1 percentage points (95% UI 18·7-21·6). During this time, traditional methods declined as a proportion of all contraceptive methods, whereas the use of implants, injections, female sterilisation, and condoms increased. Method mix differs substantially depending on age and geography, with the share of female sterilisation increasing with age and comprising more than 50% of methods in use in south Asia. In 28 countries, one method was used by more than 50% of users in 2019. INTERPRETATION The dominance of one contraceptive method in some locations raises the question of whether family planning policies should aim to expand method mix or invest in making existing methods more accessible. Lower rates of demand satisfied among women aged 15-24 years are also concerning because unintended pregnancies before age 25 years can forestall or eliminate education and employment opportunities that lead to social and economic empowerment. Policy makers should strive to tailor family planning programmes to the preferences of the groups with the most need, while maintaining the programmes used by existing users. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Annie Haakenstad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Olivia Angelino
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Caleb M S Irvine
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, University of Toronto, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Kelly Bienhoff
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Corinne Bintz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kate Causey
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - M Ashworth Dirac
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA; Swedish Family Medicine, First Hill, Seattle, WA, USA
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Thomas Glucksman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Nathaniel J Henry
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ira Martopullo
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - John Everett Mumford
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA.
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Bwire G, Ario AR, Eyu P, Ocom F, Wamala JF, Kusi KA, Ndeketa L, Jambo KC, Wanyenze RK, Talisuna AO. The COVID-19 pandemic in the African continent. BMC Med 2022; 20:167. [PMID: 35501853 PMCID: PMC9059455 DOI: 10.1186/s12916-022-02367-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 01/13/2023] Open
Abstract
In December 2019, a new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and associated disease, coronavirus disease 2019 (COVID-19), was identified in China. This virus spread quickly and in March, 2020, it was declared a pandemic. Scientists predicted the worst scenario to occur in Africa since it was the least developed of the continents in terms of human development index, lagged behind others in achievement of the United Nations sustainable development goals (SDGs), has inadequate resources for provision of social services, and has many fragile states. In addition, there were relatively few research reporting findings on COVID-19 in Africa. On the contrary, the more developed countries reported higher disease incidences and mortality rates. However, for Africa, the earlier predictions and modelling into COVID-19 incidence and mortality did not fit into the reality. Therefore, the main objective of this forum is to bring together infectious diseases and public health experts to give an overview of COVID-19 in Africa and share their thoughts and opinions on why Africa behaved the way it did. Furthermore, the experts highlight what needs to be done to support Africa to consolidate the status quo and overcome the negative effects of COVID-19 so as to accelerate attainment of the SDGs.
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Affiliation(s)
- Godfrey Bwire
- Department of Integrated Epidemiology Surveillance and Public Health Emergencies, Ministry of Health, P.O Box 7272, Kampala, Uganda
- School of Public Health, Makerere University, P.O. Box 7072, Kampala, Uganda
| | | | - Patricia Eyu
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Felix Ocom
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Kwadwo A. Kusi
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Latif Ndeketa
- Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
| | - Kondwani C. Jambo
- Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Rhoda K. Wanyenze
- School of Public Health, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Ambrose O. Talisuna
- Epidemic Preparedness and Response Cluster, World Health Organization, Regional Office for Africa, Brazzaville, Congo
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31
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Fuseini K, Jarvis L, Ankomah A, Bintou Mbow F, Hindin MJ. Did COVID-19 Impact Contraceptive Uptake? Evidence from Senegal. Stud Fam Plann 2022; 53:301-314. [PMID: 35436350 PMCID: PMC9115390 DOI: 10.1111/sifp.12195] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study assessed the impact of the COVID-19 pandemic on the number of new contraceptive acceptors in Senegal overall and by method. Monthly service data from March 2019 to December 2020 were extracted for the number of new contraceptive users of IUDs, implants, injectables, and oral contraceptive pills (OCPs). Data were analyzed using descriptive statistics and interrupted time series analysis for trend analyses overall and by the contraceptive method. Following the announcement of the first COVID-19 case in Senegal in March 2020, there was an immediate significant decrease in the number of new acceptors overall, and for new users of implants and injectables. From March-December 2020, the trend in monthly new family planning acceptors increased overall, mainly driven by significant increases in new IUD and implant acceptors. Compared to the period before the onset of COVID-19, there was a statistically significant shift from shorter-acting methods (OCPs, injectables) to long-acting reversible methods (IUDs, implants). Despite the immediate adverse impact of COVID-19-related restrictions, the number of new acceptors rebounded, trends in the number of new monthly acceptors significantly increased, and there was a significant shift to longer-acting methods.
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Affiliation(s)
- Kamil Fuseini
- Population Council, Ghana, PO Box CT 4906 Cantonments, Accra, Ghana
| | - Leah Jarvis
- Population Council, New York, One Dag Hammarskjold Plaza, New York, NY, 10017, USA
| | | | - Fatou Bintou Mbow
- Population Council, Senegal, Sacré Coeur 3 Pyrotechnie 85 Appart. 5ème étage à gauche, BP 21027 Dakar Ponty, Dakar, Sénégal
| | - Michelle J Hindin
- Evidence 4 Global Impact, 104 Barringer Court, West Orange, NJ, 07052, USA
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Banke-Thomas A, Yaya S. Looking ahead in the COVID-19 pandemic: emerging lessons learned for sexual and reproductive health services in low- and middle-income countries. Reprod Health 2021; 18:248. [PMID: 34906177 PMCID: PMC8670615 DOI: 10.1186/s12978-021-01307-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The COVID-19 pandemic has caused widespread disruption to essential health service provision globally, including in low- and middle-income countries (LMICs). Recognising the criticality of sexual and reproductive health (SRH) services, we review the actual reported impact of the COVID-19 pandemic on SRH service provision and evidence of adaptations that have been implemented to date. Across LMICs, the available data suggests that there was a reduction in access to SRH services, including family planning (FP) counselling and contraception access, and safe abortion during the early phase of the pandemic, especially when movement restrictions were in place. However, services were quickly restored, or alternatives to service provision (adaptations) were explored in many LMICs. Cases of gender-based violence (GBV) increased, with one in two women reporting that they have or know a woman who has experienced violence since the beginning of the pandemic. As per available evidence, many adaptations that have been implemented to date have been digitised, focused on getting SRH services closer to women. Through the pandemic, several LMIC governments have provided guidelines to support SRH service delivery. In addition, non-governmental organisations working in SRH programming have played significant roles in ensuring SRH services have been sustained by implementing several interventions at different levels of scale and to varying success. Most adaptations have focused on FP, with limited attention placed on GBV. Many adaptations have been implemented based on guidance and best practices and, in many cases, leveraged evidence-based interventions. However, some adaptations appear to have simply been the sensible thing to do. Where evaluations have been carried out, many have highlighted increased outputs and efficiency following the implementation of various adaptations. However, there is limited published evidence on their effectiveness, cost, value for money, acceptability, feasibility, and sustainability. In addition, the pandemic has been viewed as a homogenous event without recognising its troughs and waves or disentangling effects of response measures such as lockdowns from the pandemic itself. As the pandemic continues, neglected SRH services like those targeting GBV need to be urgently scaled up, and those being implemented with any adaptations should be rigorously tested.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- School of Human Sciences, University of Greenwich, London, UK.
- LSE Health, London School of Economics and Political Science, London, UK.
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Karp C, Moreau C, Sheehy G, Anjur-Dietrich S, Mbushi F, Muluve E, Mwanga D, Nzioki M, Pinchoff J, Austrian K. Youth Relationships in the Era of COVID-19: A Mixed-Methods Study Among Adolescent Girls and Young Women in Kenya. J Adolesc Health 2021; 69:754-761. [PMID: 34465510 PMCID: PMC8460286 DOI: 10.1016/j.jadohealth.2021.07.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/21/2021] [Accepted: 07/14/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Measures to mitigate COVID-19's impact may inhibit development of healthy youth relationships, affecting partnership quality and sexual and reproductive health (SRH) outcomes. METHODS We conducted a mixed-methods study to understand how COVID-19 affected girls' and young women's relationships in Kenya. Bivariate and multivariate logistic regression examined factors associated with relationship quality dynamics and SRH outcomes among 756 partnered adolescents aged 15-24 years. Qualitative data from in-depth interviews were analyzed using inductive thematic analysis to explore youth perceptions of how intimate relationships changed during COVID-19. RESULTS Nearly three-quarters of youth described changes in relationship quality since COVID-19 began, with 24% reporting worsening. Reduced time with partners was the strongest predictor of changed relationship quality. Youth experiencing complete or partial COVID-19-related household income loss had heightened risk of deteriorating partnerships (relative risk ratio = 2.43 and 2.02; p < .05); those whose relationships worsened were more likely to experience recent intimate partner violence, relative to no relationship change (20.8% vs. 3.5%; p < .001). Qualitative analysis revealed how COVID-19 mitigation measures hindered intimate relationships, school closures accelerated marriage timelines, and economic hardships strained relationships, while increasing early pregnancy risk and girls' financial dependency on their partners. CONCLUSIONS COVID-19 disrupted adolescent girls' and young women's romantic relationships, depriving some of partner emotional support and exposing others to sexual violence, early pregnancy, and economically motivated transactional relationships. Increased social support systems, including access to psychosocial services, are needed in low-income communities in Kilifi, Kisumu, and Nairobi, in particular the informal settlement areas, to mitigate COVID-19's consequences on girls' SRH.
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Affiliation(s)
- Celia Karp
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland.
| | - Caroline Moreau
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland; Soins et Santé Primaire, CESP Centre for Research in Epidemiology and Population Health, Inserm, Villejuif, France
| | - Grace Sheehy
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
| | - Selena Anjur-Dietrich
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
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Shapira G, Ahmed T, Drouard SHP, Amor Fernandez P, Kandpal E, Nzelu C, Wesseh CS, Mohamud NA, Smart F, Mwansambo C, Baye ML, Diabate M, Yuma S, Ogunlayi M, Rusatira RJDD, Hashemi T, Vergeer P, Friedman J. Disruptions in maternal and child health service utilization during COVID-19: analysis from eight sub-Saharan African countries. Health Policy Plan 2021; 36:1140-1151. [PMID: 34146394 PMCID: PMC8344431 DOI: 10.1093/heapol/czab064] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/01/2021] [Accepted: 05/27/2021] [Indexed: 12/31/2022] Open
Abstract
The coronavirus-19 pandemic and its secondary effects threaten the continuity of essential health services delivery, which may lead to worsened population health and a protracted public health crisis. We quantify such disruptions, focusing on maternal and child health, in eight sub-Saharan countries. Service volumes are extracted from administrative systems for 63 954 facilities in eight countries: Cameroon, Democratic Republic of Congo, Liberia, Malawi, Mali, Nigeria, Sierra Leone and Somalia. Using an interrupted time series design and an ordinary least squares regression model with facility-level fixed effects, we analyze data from January 2018 to February 2020 to predict what service utilization levels would have been in March-July 2020 in the absence of the pandemic, accounting for both secular trends and seasonality. Estimates of disruption are derived by comparing the predicted and observed service utilization levels during the pandemic period. All countries experienced service disruptions for at least 1 month, but the magnitude and duration of the disruptions vary. Outpatient consultations and child vaccinations were the most commonly affected services and fell by the largest margins. We estimate a cumulative shortfall of 5 149 491 outpatient consultations and 328 961 third-dose pentavalent vaccinations during the 5 months in these eight countries. Decreases in maternal health service utilization are less generalized, although significant declines in institutional deliveries, antenatal care and postnatal care were detected in some countries. There is a need to better understand the factors determining the magnitude and duration of such disruptions in order to design interventions that would respond to the shortfall in care. Service delivery modifications need to be both highly contextualized and integrated as a core component of future epidemic response and planning.
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Affiliation(s)
- Gil Shapira
- Development Research Group, The World Bank, 1818 H St NW, Washington, DC 20433, USA
| | - Tashrik Ahmed
- Development Research Group, The World Bank, 1818 H St NW, Washington, DC 20433, USA
| | | | - Pablo Amor Fernandez
- Development Research Group, The World Bank, 1818 H St NW, Washington, DC 20433, USA
| | - Eeshani Kandpal
- Development Research Group, The World Bank, 1818 H St NW, Washington, DC 20433, USA
| | - Charles Nzelu
- Nigeria Federal Ministry of Health, Federal Secretariat Complex, Phase III, Shehu Shagari Way, Central Business District, Abuja, Nigeria
| | | | - Nur Ali Mohamud
- Somalia Ministry of Health, Corso Somalia, Mogadishu, Somalia
| | - Francis Smart
- Sierra Leone Ministry of Health and Sanitation, Wilkinson Road, Freetown, Sierra Leone
| | | | - Martina L Baye
- Cameroun Ministére de la Sante Publiqué, Ave Marchand, Yaoundé, Cameroon
| | - Mamatou Diabate
- Ministère de la Santé et de l’Hygiène Publique du Mali, Cité Administrative Bamako, Bamako BP 232, Mali
| | - Sylvain Yuma
- Republique Democratique du Congo Ministére de la Sante, Boulevard du 30 juin #4310, Commune de la Gombe B.P. 3088 Kinshasa/Gombe, République Démocratique du Congo
| | - Munirat Ogunlayi
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H ST NW, Washington, DC, 204333, USA
| | - Rwema Jean De Dieu Rusatira
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H ST NW, Washington, DC, 204333, USA
| | - Tawab Hashemi
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H ST NW, Washington, DC, 204333, USA
| | - Petra Vergeer
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H ST NW, Washington, DC, 204333, USA
| | - Jed Friedman
- Development Research Group, The World Bank, 1818 H St NW, Washington, DC 20433, USA
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Tsui AO, Cardona C, Srivatsan V, OlaOlorun F, Omoluabi E, Akilimali P, Gichangi P, Thiongo M, Radloff S, Anglewicz P. Is Client Reporting on Contraceptive Use Always Accurate? Measuring Consistency and Change with a Multicountry Study. Stud Fam Plann 2021; 52:361-382. [PMID: 34383305 DOI: 10.1111/sifp.12172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The consistency of self-reported contraceptive use over short periods of time is important for understanding measurement reliability. We assess the consistency of and change in contraceptive use using longitudinal data from 9,390 urban female clients interviewed in DR Congo, India, Kenya, Niger, Nigeria, and Burkina Faso. Clients were interviewed in-person at a health facility and four to six months later by phone. We compared reports of contraceptive use at baseline with recall of baseline contraceptive use at follow-up. Agreement between these measures ranged from 59.1 percent in DR Congo to 84.4 percent in India. Change in both contraceptive method type (sterilization, long-acting, short-acting, nonuse) and use status (user, nonuser, discontinuer, adopter, switcher) was assessed comparing baseline to follow-up reports and retrospective versus current reports within the follow-up survey. More change in use was observed with panel reporting than within the cross section. The percent agreement between the two scenarios of change ranged from 64.8 percent in DR Congo to 84.5 percent in India, with cross-site variation. Consistently reported change in use status was highest for nonusers, followed by users, discontinuers, adopters, and switchers. Inconsistency in self-reported contraceptive use, even over four to six months, was nontrivial, indicating that studying measurement reliability of contraceptive use remains important.
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Affiliation(s)
- Amy O Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Carolina Cardona
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Varsha Srivatsan
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | | | - Elizabeth Omoluabi
- Center for Research, Evaluation Resources and Development, Ile-Ife, Osun, Nigeria.,Statistics and Population Studies Department, University of the Western Cape, Bellville, South Africa
| | | | - Peter Gichangi
- International Center for Reproductive Health, Nairobi, Kenya.,Technical University of Mombasa, Mombasa, Kenya.,Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Mary Thiongo
- International Center for Reproductive Health, Nairobi, Kenya
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- The following are other members of the PMA Agile Team: Titilope Akinlose, United Nations Foundation, Washington DC, USA; Georges Guiella and Bazie Fiacre, Institut Supérieur des Sciences de la Population, Joseph Ki-Zerbo University, 03 BP 7118 Ouagadougou, Burkina Faso; P. R. Sodani and Anupam Mehrotra, Indian Institute of Health Management and Research, Jaipur, India; Sani Oumarou and Souleymane Alzouma, Institut National de la Statistique du Niger, Niamey, Niger
| | - Scott Radloff
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Need for and use of contraception by women before and during COVID-19 in four sub-Saharan African geographies: results from population-based national or regional cohort surveys. LANCET GLOBAL HEALTH 2021; 9:e793-e801. [PMID: 34019835 PMCID: PMC8149322 DOI: 10.1016/s2214-109x(21)00105-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 12/14/2022]
Abstract
Background Although hindrances to the sexual and reproductive health of women are expected because of COVID-19, the actual effect of the pandemic on contraceptive use and unintended pregnancy risk in women, particularly in sub-Saharan Africa, remains largely unknown. We aimed to examine population-level changes in the need for and use of contraception by women during the COVID-19 pandemic, determine if these changes differed by sociodemographic characteristics, and compare observed changes during the COVID-19 pandemic with trends in the 2 preceding years. Methods In this study, we used four rounds of Performance Monitoring for Action (PMA) population-based survey data collected in four geographies: two at the country level (Burkina Faso and Kenya) and two at the subnational level (Kinshasa, Democratic Republic of the Congo and Lagos, Nigeria). These geographies were selected for this study as they completed surveys immediately before the onset of COVID-19 and implemented a follow-up specific to COVID-19. The first round comprised the baseline PMA panel survey implemented between November, 2019, and February, 2020 (referred to as baseline). The second round comprised telephone-based follow-up surveys between May 28 and July 20, 2020 (referred to as COVID-19 follow-up). The third and fourth rounds comprised two previous cross-sectional survey rounds implemented in the same geographies between 2017 and 2019. Findings Our analyses were restricted to 7245 women in union (married or living with a partner, as if married) who were interviewed at baseline and COVID-19 follow-up. The proportion of women in need of contraception significantly increased in Lagos only, by 5·81 percentage points (from 74·5% to 80·3%). Contraceptive use among women in need increased significantly in the two rural geographies, with a 17·37 percentage point increase in rural Burkina Faso (30·7% to 48·1%) and a 7·35 percentage point increase in rural Kenya (71·6% to 78·9%). These overall trends mask several distinct patterns by sociodemographic group. Specifically, there was an increase in the need for contraception among nulliparous women across all geographies investigated. Interpretation Our findings do not support the anticipated deleterious effect of COVID-19 on access to and use of contraceptive services by women in the earliest stages of the pandemic. Although these results are largely encouraging, we warn that these trends might not be sustainable throughout prolonged economic hardship and service disruptions. Funding Bill & Melinda Gates Foundation. Translation For the French translation of the abstract see Supplementary Materials section.
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