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Marcelino AC, da Cunha Pereira P, Charles CM'P, Bahamondes L. A particular epidemiological profile: disparities in access to contraceptive methods in Brazil during the SARS-CoV-2 (COVID-19) pandemic. Sci Rep 2024; 14:14982. [PMID: 38951554 PMCID: PMC11217427 DOI: 10.1038/s41598-024-65946-w] [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: 01/28/2024] [Accepted: 06/24/2024] [Indexed: 07/03/2024] Open
Abstract
Our objective was to study disparities in access to contraception during the COVID-19 pandemic. We performed a cross-sectional study at the University of Campinas, Brazil using a Google questionnaire applied from December 2021 until February 2022, disseminated via snowball technique. The survey asked about sociodemographic characteristics and contraceptive use, as well as the demand for new methods and difficulties in continuing to use contraceptives during the COVID-19 pandemic. We analyzed 1018 completed questionnaires; in total, 742 (72.9%) were women aged between 20 and 39 years, 746 (73.3%) were White and 602 (59.2%) used contraceptives. During the COVID-19 pandemic, about 23% of respondents changed their method and approximately 20% of respondents looked for new methods. Among the latter, 31.3% reported some difficulty with obtaining guidance on new methods while only 5.3% of the respondents reported some difficulty with continuing their contraceptive. The main difficulty in both cases was the difficulty with getting a healthcare provider appointment. Our results point to a particular epidemiological population, of younger black and biracial women, with lower education and lower income, which suffered health disparities during the COVID-19 pandemic and found difficulties with using contraceptives and accessing family planning services.
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Affiliation(s)
- Ana C Marcelino
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Caixa Postal 6181, Campinas, SP, 13084-971, Brazil
| | - Paula da Cunha Pereira
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Caixa Postal 6181, Campinas, SP, 13084-971, Brazil
| | - Charles M 'Poca Charles
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Caixa Postal 6181, Campinas, SP, 13084-971, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Caixa Postal 6181, Campinas, SP, 13084-971, Brazil.
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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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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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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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Odwe G, McCann B, Liambila W, Vandermark J, Mwanga D, Anab E, Wanami M, Ramarao S. Feasibility of e-commerce pharmacy provision and acceptability of levonorgestrel 1.5 mg for pericoital use in urban and peri-urban settings in Kenya: a prospective cohort study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:35-42. [PMID: 36323492 PMCID: PMC9872235 DOI: 10.1136/bmjsrh-2022-201653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION An 'on-demand' contraceptive pill may suit women having infrequent sex. We assessed the feasibility of e-commerce pharmacy provision and acceptability of levonorgestrel (LNG) 1.5 mg for pericoital use in Kenya. METHODS A 12-month prospective, single-arm, open-label, interventional study conducted from August 2020 to August 2021. A total of 897 women aged 18-49 years at risk of pregnancy and having infrequent sex (ie, six times or fewer coital frequency/month) were screened and enrolled. We undertook univariate and bivariate analysis on multiple data points: enrolment dataset, bimonthly surveys, extended survey around 6-month follow-up, and e-commerce pharmacy sales log. RESULTS A total of 2291 pericoital LNG 1.5 mg pill doses were dispensed to 300 women over a 12-month period mainly via the USSD (Unstructured Supplementary Service Data) platform. Of the 266 women who obtained the pill and completed the survey, most (83%) were satisfied/very satisfied with e-commerce platform services, citing convenience and ease of use. The pill was also acceptable. Of the 266 women who used it at least once, 94% were satisfied/very satisfied, likely to continue using and would recommend it to others; 86% used it within 24 hours before/after sex as recommended and most of the time they had sex; and 147 (55%) experienced side effects, mainly nausea, headache, changes in menstrual pattern, cramps and dizziness that were mild and tolerable. CONCLUSIONS E-commerce pharmacy provision of LNG 1.5 mg for pericoital use is feasible. In addition, a pericoital LNG 1.5 mg pill is acceptable among women having infrequent sex and could potentially address their unmet family planning needs.
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Affiliation(s)
- George Odwe
- Reproductive Health, Population Council - Kenya, Nairobi, Kenya
| | | | - Wilson Liambila
- Reproductive Health, Population Council - Kenya, Nairobi, Kenya
| | | | - Daniel Mwanga
- Data Science and Evaluation, African Population and Health Research Center, Nairobi, Kenya
| | | | | | - Saumya Ramarao
- Reproductive Health, Population Council Inc, New York City, New York, USA
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