Impacts of COVID-19 on contraceptive and abortion services in low- and middle-income countries: a scoping review

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 Of 71 studies included, the majority (61%) were not peer-reviewed, and 42% were based in Africa, 35% in Asia, 17% were multi-region, and 6% were in Latin America and the Caribbean.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.

Effect of Covid Pandemic Upon Utilization of Contraceptive Services

“…Whereas more than two-thirds of women found it difficult to obtaining health care. Women's ability to manage primary care is demonstrated by utilization of contraception in 26% women [18,19]. Furthermore, during COVID-19, one out of five women substituted techniques, with the majority switching to ways that were equally successful in their approach before pandemic.…”

Setting Health Targets Using Information from Probabilistic Projections: A Research Brief on an Application to Contraceptive Coverage

“…We use 2019 as the baseline and thus make no assumptions about the scale or duration of the COVID-19 pandemic’s impact on contraceptive service provision, use or need. Recent evidence from a scoping review provides no basis to make uniform assumptions about pandemic-related changes in contraceptive use or service provision (Polis et al, 2022 ). We use the country-specific change in the percent of demand satisfied by modern methods in 2019 and 2030 (the end point of the SDGs).…”

Associations between sexual and reproductive health knowledge, attitude and practice of partners and the occurrence of unintended pregnancy

“…In addition, a qualitative study of young women under the age of 30 in six countries reported that among women who do not have access to abortion services due to COVID-19, some women choose to use medical abortions at home ( 44 ), and others seek unsafe abortions in local informal abortion facilities, increasing the incidence of complications such as infertility, reproductive system infections, and severe gynecological diseases, which can lead to maternal death. As a result, the overall level of contraceptive use reported in population-based surveys has increased to some extent as the pandemic has progressed, along with an increase in the demand for contraceptive and abortion information and a greater desire for access to knowledge ( 45 , 46 ).…”