Women’s Experiences With Family Planning Under COVID-19: A Cross-Sectional, Interactive Voice Response Survey in Malawi, Nepal, Niger, and Uganda

Surveyed women attributed unintended pregnancies to COVID-19 and reported constraints to contraceptive access and use in Malawi, Nepal, Niger, and Uganda. Key Findings Between 27% and 44% of pregnant women surveyed in each country indicated that the pandemic affected their ability to delay or avoid pregnancy. Fewer surveyed women in potential need of contraception reported current use of modern contraception compared to before the pandemic in all countries except Niger. Supply-side constraints, including service closures and product shortages, were among the most common barriers to contraceptive access and use reported by women. Fear of coronavirus disease (COVID-19) infection and lack of money also constrained access and use. Results linked the unavailability of one’s preferred method to nonuse and unintended pregnancies, indicating that elasticity of demand is limited. Key Implications Experiences with family planning services during the COVID-19 pandemic provide an opportunity to learn lessons to improve preparedness for future crises. Policy makers should incorporate multimonth supply of contraceptives to clients in guidance documents. Program managers should consider strategies to ensure continued availability of the full method mix during crises, particularly since disruptions may go unnoticed. Program managers should strengthen the provision of services through alternative service delivery channels to mitigate service disruptions. ABSTRACT Introduction: We conducted an assessment in Malawi, Nepal, Niger, and Uganda to document access-related reasons for not using contraceptive methods during the COVID-19 pandemic that led to unintended pregnancies, describe use of modern contraception among women in potential need of contraception compared to before the pandemic, examine method choice, and describe barriers to contraceptive access and use. Methods: Between December 2020 and May 2021, we conducted an opt-in phone survey with 21,692 women, followed by an outbound survey with 5,124 women who used modern nonpermanent contraceptive methods or who did not want to get pregnant within 2 years but were not using a modern contraceptive method. The surveys examined current behaviors and documented behaviors before the pandemic retrospectively. We used multivariable logistic regression models to examine factors associated with contraceptive use dynamics during COVID-19. Results: Pregnant women surveyed reported that the pandemic had affected their ability to delay or avoid getting pregnant, ranging from 27% in Nepal to 44% in Uganda. The percentage of respondents to the outbound survey using modern contraception decreased during the pandemic in all countries except Niger. Fear of COVID-19 infection was associated with discontinuing modern contraception in Malawi and with not adopting a modern method among nonusers in Niger. Over 79% of surveyed users were using their preferred method. Among nonusers who tried obtaining a method, reasons for nonuse included unavailability of the preferred method or of providers and lack of money; nonusers who wanted a method but did not try to obtain one cited fear of COVID-19 infection. Conclusion: We found evidence of surveyed women attributing unintended pregnancies to the pandemic and examples of constraints to contraceptive access and use on the supply and demand side. The effects of the pandemic must be interpreted within the local contraceptive, health system, and epidemiological context.