Contraceptive dynamics during COVID-19 in sub-Saharan Africa: longitudinal evidence from Burkina Faso and Kenya

Karp, Celia; Wood, Shannon N.; Guiella, Georges; Gichangi, Peter; Bell, Suzanne O.; Anglewicz, Philip; Larson, Elizabeth; Zimmerman, Linnea; Moreau, Caroline

doi:10.1136/bmjsrh-2020-200944

Cited by 51 publications

(74 citation statements)

References 17 publications

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“…In part, the pandemic may differentially impact the demand for different types of services. In surveys with women at risk of unintended pregnancy in Burkina Faso and Kenya, a small share of the sample stated that COVID-19-related reasons affected the non-use of family planning methods ( Karp et al. , 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Disruptions in maternal and child health service utilization during COVID-19: analysis from eight sub-Saharan African countries

Shapira

Ahmed

Drouard

et al. 2021

Health Policy and Planning

145

219

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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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Section: Discussionmentioning

confidence: 99%

Disruptions in maternal and child health service utilization during COVID-19: analysis from eight sub-Saharan African countries

Shapira

Ahmed

Drouard

et al. 2021

Health Policy and Planning

145

219

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“…13 Our results align with individual-level data indicating minimal shifts in contraceptive status in Kenya and Burkina Faso. 17 Stratified analyses by residence revealed discernable differences in key contraceptive indicators. In contrast to our initial hypothesis, we found an increase in contraceptive use in the COVID-19 period in Kenya and rural Burkina Faso, but similar rises were not observed in Kinshasa or Lagos, where previous progress in meeting women's demand for contraception seemed to have stalled.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies provide such timely information, and many rely on health systems data, 15,16 which do not necessarily reflect population-level changes in contraceptive use. Individual-level data from Burkina Faso and Kenya highlight little change in contraceptive use as a result of COVID-19; 17 however, population-level data are needed to capture overall trends.…”

Section: Introductionmentioning

confidence: 99%

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

Wood

Karp

OlaOlorun

et al. 2021

The Lancet Global Health

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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. MethodsIn 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.

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“…According to the available data, financial barriers continue being the main reason for not accessing healthcare for most respondents, while COVID-19 related reasons were reported only in two countries. Only 4 percent of women at risk of unintended pregnancy and not using contraception in Burkina Faso reported a COVID-19-related reason for non-use (Karp et al 2020). It should also be noted in this regard that the decrease in access may partially be due to fear of contracting COVID-19 and/or postponement of pregnancy.…”

Section: Disruptions In Service Deliverymentioning

confidence: 99%

Gender and COVID-19: What have we Learnt, One Year Later?

Nieves¹,

Gaddis²,

Müller³

2021

Policy Research Working Papers

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The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about development issues. An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry the names of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the International Bank for Reconstruction and Development/World Bank and its affiliated organizations, or those of the Executive Directors of the World Bank or the governments they represent.

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Contraceptive dynamics during COVID-19 in sub-Saharan Africa: longitudinal evidence from Burkina Faso and Kenya

Cited by 51 publications

References 17 publications

Disruptions in maternal and child health service utilization during COVID-19: analysis from eight sub-Saharan African countries

Disruptions in maternal and child health service utilization during COVID-19: analysis from eight sub-Saharan African countries

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

Gender and COVID-19: What have we Learnt, One Year Later?

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