Contraceptive access and use before and during the COVID-19 pandemic: a mixed-methods study in South Africa and Zambia.
Humans
COVID-19
/ epidemiology
Zambia
/ epidemiology
South Africa
/ epidemiology
Female
Health Services Accessibility
Adult
Contraception
/ statistics & numerical data
Family Planning Services
/ methods
SARS-CoV-2
Contraception Behavior
Young Adult
Pandemics
Adolescent
Longitudinal Studies
Surveys and Questionnaires
Intrauterine Devices
COVID-19
LARC removal
Long-acting reversible contraception (LARC)
South Africa
Zambia
contraception
family planning
mixed methods
Journal
Gates open research
ISSN: 2572-4754
Titre abrégé: Gates Open Res
Pays: United States
ID NLM: 101717821
Informations de publication
Date de publication:
2023
2023
Historique:
accepted:
10
07
2024
pubmed:
27
4
2023
medline:
1
8
2024
entrez:
1
8
2024
Statut:
epublish
Résumé
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. 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. Contraceptive use changed minimally in this sample with the emergence of COVID-19. Fewer than half of women (n=220) reported that they tried to access FP since the start of the pandemic. The vast majority of those seeking services were using short-acting methods and 95% were able to obtain their preferred method. The proportion of women not using a method before and after the start of the pandemic did not change in Zambia (31%), and increased from 8% to 10% in South Africa. Less than 7% of implant or IUD users in either country reported wanting removal. Among the 22 who sought removal, 10 in Zambia and 6 in South Africa successfully obtained removal. In qualitative interviews, those reporting challenges to service access specifically 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. We did not find a substantial impact of COVID-19 on contraceptive access and use 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.
Sections du résumé
Background
UNASSIGNED
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
UNASSIGNED
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
UNASSIGNED
Contraceptive use changed minimally in this sample with the emergence of COVID-19. Fewer than half of women (n=220) reported that they tried to access FP since the start of the pandemic. The vast majority of those seeking services were using short-acting methods and 95% were able to obtain their preferred method. The proportion of women not using a method before and after the start of the pandemic did not change in Zambia (31%), and increased from 8% to 10% in South Africa. Less than 7% of implant or IUD users in either country reported wanting removal. Among the 22 who sought removal, 10 in Zambia and 6 in South Africa successfully obtained removal. In qualitative interviews, those reporting challenges to service access specifically 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
UNASSIGNED
We did not find a substantial impact of COVID-19 on contraceptive access and use 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.
Identifiants
pubmed: 39086400
doi: 10.12688/gatesopenres.14590.1
pmc: PMC11290906
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
61Informations de copyright
Copyright: © 2024 Callahan RL et al.
Déclaration de conflit d'intérêts
No competing interests were disclosed.