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

Abstract

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.

Effect of COVID-19 pandemic on provision of sexual and reproductive health services in primary health facilities in Nigeria: a cross-sectional study

“…A study in China reported evidence of disruptions in antenatal, delivery, and postnatal care, abortion services, and stock-out of contraceptives [ 24 ]. A study conducted in four sub-Saharan African countries reported significant increase in contraceptive need and use among women in a marital union during the early stage of the pandemic [ 25 ]. However, the study also indicated that the trend may change.…”

Disruption in essential health services in Mexico during COVID-19: an interrupted time series analysis of health information system data

“…34 In contrast, another recent study found an increase in contraceptive use among women in need in rural Burkina Faso and rural Kenya. 35 Declines in antenatal care coverage, child vaccination and sick child care may place the IMSS population at risk for excess maternal and child morbidity and mortality not attributable to COVID-19. An increase in maternal mortality has already been reported in Mexico.…”

Looking ahead in the COVID-19 pandemic: emerging lessons learned for sexual and reproductive health services in low- and middle-income countries

“…Analysis of the Performance Monitoring for Action data found non-significant increases in the proportion of women needing contraception in Burkina Faso and Kenya and Kinshasa, Democratic Republic of Congo, with Lagos, Nigeria the only setting showed significantly increased need [ 26 ]. As per the same study, there was a 17.4% increase (30.7–48.1%) and 7.4% increase (71.6–78.9%) in the proportion of women of reproductive age who used contraception in rural Burkina Faso and Kenya respectively.…”

“…As per the same study, there was a 17.4% increase (30.7–48.1%) and 7.4% increase (71.6–78.9%) in the proportion of women of reproductive age who used contraception in rural Burkina Faso and Kenya respectively. Apart from urban Kenya, no significant differences in contraception use were reported in the urban areas studied [ 26 ]. A separate study largely agreed that there was no significant difference in contraceptive use before and during the pandemic in Lagos.…”

“…Some interventions were also the sensible thing to do. For example, though FP utilisation did not massively reduce, especially in urban areas, there was still some reduction [ 26 ], and lockdown at home limited use for younger women who were living at home with their parents [ 27 ]. In addition to other factors, the fear of contracting the virus while engaging with health facilities was reported by frontline health workers across the globe [ 50 ] and in local surveys of women themselves.…”