Contraceptive access and use before and during the COVID-19 pandemic: a mixed-methods study in South Africa and Zambia

Background 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 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 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 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.

[1]  A. Hennis,et al.  What is the NCD service capacity and disruptions due to COVID-19? Results from the WHO non-communicable disease country capacity survey in the Americas region , 2023, BMJ Open.

[2]  M. Beksinska,et al.  Contraceptive Continuation and Experiences Obtaining Implant and IUD Removal Among Women Randomized to Use Injectable Contraception, Levonorgestrel Implant, and Copper IUD in South Africa and Zambia. , 2023, Studies in family planning.

[3]  Rahul Pratap Singh Kaurav,et al.  NVivo , 2022, Encyclopedia of Tourism Management and Marketing.

[4]  James F Fitzgerald,et al.  Minimizing COVID-19 disruption: Ensuring the supply of essential health products for health emergencies and routine health services , 2021, The Lancet Regional Health - Americas.

[5]  R. Steiner,et al.  COVID-19 and family planning service delivery: Findings from a survey of U.S. physicians , 2021, Preventive Medicine.

[6]  F. OlaOlorun,et al.  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 , 2021, The Lancet. Global health.

[7]  P. Gichangi,et al.  Contraceptive dynamics during COVID-19 in sub-Saharan Africa: longitudinal evidence from Burkina Faso and Kenya , 2021, BMJ Sexual & Reproductive Health.

[8]  Alexandria K. Mickler,et al.  Applications of the High Impact Practices in Family Planning during COVID-19 , 2021, Sexual and reproductive health matters.

[9]  M. Monze,et al.  First 100 Persons with COVID-19 — Zambia, March 18–April 28, 2020 , 2020, MMWR. Morbidity and mortality weekly report.

[10]  A. Pfitzer,et al.  Opportunities and Challenges of Delivering Postabortion Care and Postpartum Family Planning During the COVID-19 Pandemic , 2020, Global Health: Science and Practice.

[11]  V. Kantorová,et al.  The impact of the COVID-19 crisis on meeting needs for family planning: a global scenario by contraceptive methods used , 2020, Gates open research.

[12]  B. Hayes,et al.  Doing Things Differently: What It Would Take to Ensure Continued Access to Contraception During COVID-19 , 2020, Global Health: Science and Practice.

[13]  S. Naidoo,et al.  Don't Let Sexual and Reproductive Health become Collateral Damage in the Face of the COVID-19 Pandemic: A Public Health Perspective. , 2020, African journal of reproductive health.

[14]  J. Seeley,et al.  Access to primary healthcare during lockdown measures for COVID-19 in rural South Africa: a longitudinal cohort study , 2020, medRxiv.

[15]  K. Nanda,et al.  Contraception in the Era of COVID-19 , 2020, Global Health: Science and Practice.

[16]  R. Trimble COVID-19 Dashboard , 2020 .

[17]  Paul A. Harris,et al.  The REDCap consortium: Building an international community of software platform partners , 2019, J. Biomed. Informatics.

[18]  Douglas J. Taylor,et al.  HIV incidence among women using intramuscular depot medroxyprogesterone acetate, a copper intrauterine device, or a levonorgestrel implant for contraception: a randomised, multicentre, open-label trial , 2019, The Lancet.

[19]  Loriene Roy What Is a Reference Source? , 2018, The Reference Librarian.

[20]  Kathleen M. MacQueen,et al.  Applied Thematic Analysis , 2011 .

[21]  Eleanor McLellan,et al.  Beyond the Qualitative Interview: Data Preparation and Transcription , 2003 .

[22]  P. Sedgwick,et al.  Study design , 1986, BMJ : British Medical Journal.

[23]  L. Baldwin-Ragaven,et al.  Early Effects of the COVID-19 Pandemic on Family Planning Utilisation and Termination of Pregnancy Services in Gauteng, South Africa: March–April 2020 , 2020, Wits Journal of Clinical Medicine.