Change in childbearing intention, use of contraception, unwanted pregnancies, and related adverse events during the COVID-19 pandemic: Results from a panel study in rural Burkina Faso

Health Planning in Times of COVID-19 in Burkina Faso: The Role of Its National Strategic Pandemic Management Committee

CONTEXT

Presenting the COVID-19 crisis as a pandemic misleadingly implies a certain homogeneity between the regions of the Globe in terms of their burden and reactions. However, from the outset of the crisis, countries presented different epidemiological realities and sometimes adopted divergent, even opposing measures. Curiously, the heterogeneity of responses persisted as scientific evidence accumulated about COVID-19 and the strategies for dealing with it.

CASE STUDY

This commentary aims to recount the specific experience of Burkina Faso, and how it reoriented its initial biomedical response into a multisectoral strategy. Burkina Faso set up a committee specifically to examine the effects not only of the pandemic, but also of the control measures. This committee was mandated to decompartmentalize the lens through which the COVID-19 was dealt with. It entered into dialogue with a level of stakeholders often overlooked during national health crisis: communities. As a member of this "National Committee for Crisis Management of the Pandemic", one of the co-authors contributed to its orientations and has witnessed first-hand some of the challenges it faced.

RECOMMENDATIONS

This experience suggests that the project of extricating the field of public health from medicine is advancing in Burkina Faso. In order to manage future crises more effectively and across different sectors, there is an urgent need to establish state structures and to strengthen public health systems. States need coordination units that have the legitimacy, authority and resources required to mobilize a variety of actors at the community, national and international levels.

The impact of the COVID-19 pandemic on reproductive intentions and contraceptive use among females in Jeddah, Saudi Arabia

OBJECTIVE

Pandemics have affected many people's social and emotional lives. Conception planning, contraceptive usage, and pregnancy intentions are activities with minimal research. This study is the first to evaluate how the COVID-19 pandemic influenced reproductive plans and contraceptive use among women during the pandemic in Jeddah, Saudi Arabia, in 2022.

METHODS

A cross-sectional survey was conducted by sending an online questionnaire to married women from Jeddah, Saudi Arabia. The questionnaire included demographics, personal obstetrics information, changes in pregnancy intentions owing to the COVID-19 pandemic, and questions about contraceptive usage. Qualitative data were presented as frequencies, and a χ2 test was performed to determine the relationships among the variables.

RESULTS

A total of 639 women enrolled in the study; most participants were 25-34 years old, and most indicated they changed their reproductive intentions during the pandemic (49%). Family planning accounted for 25.8% of participants who changed their reproductive intentions. Only 17.5% changed their choices because of fear of the COVID-19 impact. The percentage of women using contraception was significantly reduced during the lockdown, to 36.8%. Oral contraceptive pills were the most frequently used method during the curfew period (17.5%).

CONCLUSION

The COVID-19 lockdown affected the reproductive intentions of most women in Jeddah, and it significantly reduced contraceptive use.

Vaccination coverage in rural Burkina Faso under the effects of COVID-19: evidence from a panel study in eight districts

BACKGROUND

Improving infant immunization completion and promoting equitable vaccination coverage are crucial to reducing global under-5 childhood mortality. Although there have been hypotheses that the impact of the COVID-19 pandemic would decrease the delivery of health services and immunization campaigns in low- and middle-income countries, the available evidence is still inconclusive. We conducted a study in rural Burkina Faso to assess changes in vaccination coverage during the pandemic. A secondary objective was to examine long-term trends in vaccination coverage throughout 2010-2021.

METHODS

Using a quasi-experimental approach, we conducted three rounds of surveys (2019, 2020, 2021) in rural Burkina Faso that we pooled with two previous rounds of demographic and household surveys (2010, 2015) to assess trends in vaccination coverage. The study population comprised infants aged 0-13 months from a sample of 325 households randomly selected in eight districts (n = 736). We assessed vaccination coverage by directly observing the infants' vaccination booklet. Effects of the pandemic on infant vaccination completion were analyzed using multi-level logistic regression models with random intercepts at the household and district levels.

RESULTS

A total of 736 child-year observations were included in the analysis. The proportion of children with age-appropriate complete vaccination was 69.76% in 2010, 55.38% in 2015, 50.47% in 2019-2020, and 64.75% in 2021. Analyses assessing changes in age-appropriate full-vaccination coverage before and during the pandemic show a significant increase (OR: 1.8, 95% CI: 1.14-2.85). Our models also confirmed the presence of heterogeneity in full vaccination between health administrative districts. The pandemic could have increased inequities in infant vaccination completion between these districts. The analyses suggest no disruption in age-appropriate full vaccination due to COVID-19. Our findings from our sensitivity analyses to examine trends since 2010 did not show any steady trends.

CONCLUSION

Our findings in Burkina Faso do not support the predicted detrimental effects of COVID-19 on the immunization schedule for infants in low- and middle-income countries. Analyses comparing 2019 and 2021 show an improvement in age-appropriate full vaccination. Regardless of achieving and sustaining vaccination coverage levels in Burkina Faso, this should remain a priority for health systems and political agendas.

The impact of the COVID-19 pandemic on contraceptive methods, abortion, and unintended pregnancy: a cross-sectional study

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.

Comparing reproductive intentions before and during the COVID-19 pandemic: a cross-sectional study

BACKGROUND AND AIM

Reproductive behaviors and intentions are affected by several factors, including the COVID-19 pandemic crisis. This study was conducted with the aim of comparing the intention to reproduce and its causes in Iran during the period prior to and during the COVID-19 pandemic.

METHODS

This descriptive-comparative study included 425 cisgender women from 6 urban health centers and 10 rural centers in Babol city, Mazandaran province, Iran. Urban and rural health centers were selected using a multi-stage approach with proportional allocation. A questionnaire was used to collect data in relation to individual characteristics and reproductive intentions.

RESULTS

Most participants aged between 20 and 29 years had a diploma level of education, were housewives and lived in the city. The intention to reproduce decreased from 11.4% before the pandemic to 5.4% during the pandemic (p = 0.006). The most common reason for wanting to have children prior to the pandemic was not having children (54.2%). During the pandemic, a desire to reach the ideal number of children was the most common reason to want to have children (59.1%), though no statistically significant difference was observed between the two periods (p = 0.303). The most common reason for not wanting to have children in both periods was having enough children already (45.2% before and 40.9% during the pandemic). The reasons for not wanting to have children had a statistically significant difference between the two periods (p < 0.001). Reproductive intentions had a statistically significant relationship with the variables of age (p < 0.001), the education level of both participants (p < 0.001) and spouses (p = 0.006), occupation (p = 0.004), and socio-economic status (p < 0.001).

CONCLUSION

Despite restrictions and lockdowns, the COVID-19 pandemic had a negative impact on people's desire to reproduce in this context. Economic problems caused by the sanctions which increased during the COVID-19 crisis may be one of the reasons for a reduction in people's intentions to become parents. Future research could usefully investigate whether this decrease in the desire to reproduce will lead to significant changes in population level and future birth rates.

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

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.

Does abolishing user fees for family planning increase contraception use? An impact evaluation of the national policy in Burkina Faso

Background

Unmet needs for contraception constitute a major public health problem in sub-Saharan Africa. Several mechanisms have been tested to reduce the financial barrier and facilitate access to family planning services, with inconclusive results. Based on the positive impacts following the introduction of free health care for pregnant women, Burkina Faso decided to extend its national policy and abolished direct payment for family planning services. This study aims to evaluate the impact of this policy on contraceptive use and unmet needs for contraception among women of reproductive age (WRA) in Burkina Faso.

Methods

This study uses two different study designs to examine the impact of a user fee removal policy on contraceptive use across a panel of 1400 households randomly selected across eight health districts. Data were collected using a standardized socio-demographic questionnaire at three different time points during the pilot and scale-up phases of the fee abolition program. The questionnaire was administered six months after the launch of the pilot fee abolition program in four health districts. For the remaining four health districts, the survey was conducted one year prior to and six months after the implementation of the program in those areas. All WRA in the households were eligible to participate. A cross-sectional study design was used to determine the association between knowledge of the fee abolition policy among WRA and actual use of contraceptives by WRA six months after the policy’s implementation and across all eight districts. Additionally, a pre-post study with a non-randomized, reflexive control group was designed using repeated surveys in four health districts. Hierarchical logistic mixed effects models were adjusted for a set of time-variant individual variables; the impact was assessed by a difference-in-differences approach that compared pre-post changes in contraception use in women who knew about the new policy and those who did not.

Results

Of the 1471 WRA surveyed six months after the removal of user fees for family planning services, 56% were aware of the policy’s existence. Knowledge of the fee abolition policy was associated with a 46% increase probability of contraceptive use among WRA six months after the policy’s implementation. Among the subset of the participants who were surveyed twice (n = 507), 65% knew about the fee removal policy six months after its introduction and constitute the intervention group. Pre-post changes in contraceptive use differed significantly between the intervention (n = 327) and control groups (n = 180). Removing user fees for family planning led to an 86% (95% confidence interval (CI) = 0.49, 1.31) increase in the likelihood of using contraception. In the study area, the policy reduced the prevalence of unmet needs for contraception by 13 percentage points.

Conclusions

Removing user fees for family planning services is a promising strategy to increase access to, and reduce unmet needs for, contraception. A broader dissemination of the policy’s existence will likely increase its impact on the overall population.

The Impacts of the COVID-19 Pandemic on Fertility Intentions of Women with Childbearing Age in China

On 31 May 2021, the Political Bureau of the Central Committee of the Communist Party of China proposed the policy that a couple can have three children, and rolled out more supportive measures to further optimize the fertility policies. However, while the Chinese government is further optimizing its fertility policy, the sudden outbreak of COVID-19 is raging around the world, which threatens the implementation of China’s fertility optimization policy. Based on this, this paper firstly explores the impact of COVID-19 on women’s fertility intentions. Secondly, based on the Theory of Planned Behavior, this paper constructs a structural equation model to quantitatively reveal the specific factors that affect women’s fertility intentions under the epidemic, as well as their impact paths, and then puts forward corresponding suggestions for the government to solve the problem of fertility, aiming at delaying population aging and optimizing population structure. The research results show that: (1) COVID-19 lowers the fertility intentions of women of childbearing age. (2) During the pandemic, economic pressure emerged as the biggest factor affecting women’s fertility intentions. The decline in income caused by the pandemic has become an important factor in preventing women from having children. (3) The conflict between work and childbearing is still an important factor affecting the fertility intentions of women of childbearing age. The government’s provision of perfect childcare services and their strengthening of the protection of women’s employment rights and interests will greatly reduce women’s anxiety about childbearing.