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The COVID-19 pandemic has affected the sexual and reproductive health needs of women in all settings. To curb the spread of the disease in sub-Saharan Africa, many governments have imposed early lockdown measures, including closing borders, enforcing curfews and restrictions on movement.
During these first periods of containment (around March to June 2020), modeling projections and data collected from health providers warned that women would have difficulty accessing sexual and reproductive health care, including sexual and reproductive health care. contraceptive services.
Health services have been threatened in several ways. Clinical staff in charge of COVID-19 interventions had limited access to personal protective equipment. The closure of workplaces and transport services affected supply lines, and stockouts of many contraceptive methods were observed over the next three to six months. Fears of an increased risk of COVID-19 infection in healthcare facilities have discouraged women from seeking services.
In some settings, clinical activities deemed “non-urgent”, such as antenatal care, were often delayed. At the same time, confinement itself may have increased women’s exposure to gender-based violence due to longer periods in the presence of abusers, usually intimate partners, and more limited opportunities to seek help. .
Read more: Sexual and gender-based violence during COVID-19: Lessons from Ebola
The first reports were useful in advocating for women’s sexual and reproductive health needs. But few studies have been able to quantify the real impact of the COVID-19 pandemic and its mitigation measures on the lives and well-being of women. Specifically, population-level data was needed to help us understand how the pandemic has affected the need for and use of contraception by women – and to identify who might be most at risk of experiencing an unwanted pregnancy. .
In our recent research, we sought to answer these questions by interviewing women in four African countries. We looked at the impact of COVID-19 on their sexual and productive health needs and access. What we found was surprising and contrary to the fears of experts and activists. Overall, the women we spoke to were able to prevent unintended pregnancies. But women’s need for contraception and contraceptive use must be an ongoing priority. The results showed that certain groups were particularly vulnerable.
Need and use of contraceptives
The Performance Monitoring for Action study conducts annual surveys of women’s reproductive health needs in sub-Saharan Africa. These investigations are generally carried out face to face by qualified investigators. But due to COVID-19 mitigation measures, normal procedures were not possible.
We therefore conducted a telephone survey from May to June 2021. The survey included questions specific to COVID-19 knowledge and reproductive health behaviors since the COVID-19 restrictions.
Our analyzes focused on 7,245 women married or living with a partner in Burkina Faso, Kinshasa (Democratic Republic of the Congo), Kenya and Lagos (Nigeria). We included these geographic areas because we had already collected data between November 2019 and February 2020 – just before the COVID-19 pandemic – and could compare key reproductive health indicators between time points.
The need for contraception and the actual use of contraception differed considerably in the four geographic areas.
Lagos was the only place where women’s need for contraception increased. It increased by 5% between the pre-COVID-19 period and the investigation that followed the start of the pandemic. No increase in contraceptive need has been observed in other settings.
Contrary to our expectations, we have found that overall contraceptive use among women requiring contraception has increased in most settings. This increase has been significant in rural areas of Burkina Faso and Kenya.
In all four geographies, we found that the economic fallout from the pandemic has had an impact on the lives of women.
Most women have reported a partial loss of household income since the COVID-19 restrictions. In Kinshasa, however, the impact has been more severe. Almost 70% of women reported a total loss of household income. As a result, increases in contraceptive use were observed among women who had suffered partial economic losses in Kenya and in rural areas of Burkina Faso, possibly reflecting shifting fertility intentions in times of decline. economic uncertainty.
Fortunately, our overall findings do not match predictions and media reports that there are high numbers of unintended pregnancies due to reduced access to reproductive health services. In fact, our results on the overall increase in contraceptive use in Kenya and rural areas of Burkina Faso indicate that women act according to their reproductive preferences and seek to prevent pregnancy.
However, it is important to note that some women may not have been able to use contraception to prevent unwanted pregnancies in the early stages of the pandemic. We also examined these trends by socio-demographic characteristics. We have found that some women may be at increased risk of unwanted pregnancy – in particular, young women in Lagos and women without children in Kinshasa. Understanding the reasons for the increase in contraceptive need and the decrease in contraceptive use is essential for these groups.
Young women already face stigma when accessing contraceptive services and this is likely to be increased during the pandemic due to the closure of youth friendly services. Women who have never had children may also face family and societal pressures to conceive soon after marriage, regardless of their competing financial or educational aspirations. Ensuring that all women and girls are able to achieve their reproductive goals must remain essential throughout the pandemic and beyond.
Read more: Why Nigeria’s weak health system affects women and girls the most
Look ahead
Overall, these results are encouraging.
But the sexual and reproductive health needs of women and girls must remain a priority for governments, international donors and service providers. This is especially important as many countries are experiencing new waves of COVID-19 cases and entering periods of continued restrictions.
Contraception should be seen as a basic need in sub-Saharan Africa and other places where health systems are weak and fragile. Access should not be affected by pandemics or other situations requiring movement restrictions.
Family planning policies and programs in these settings should prioritize the reproductive and sexual health needs of women at all times. And even more so during health emergencies, where women also face disproportionate economic and societal setbacks.
Shannon N. Wood works for the Johns Hopkins Bloomberg School of Public Health and has received funding from the Bill and Melinda Gates Foundation for this work.
Celia Karp works for the Johns Hopkins Bloomberg School of Public Health and has received funding from the Bill and Melinda Gates Foundation for this work.
Funmilola OlaOlorun is affiliated with the Bill and Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins University and has received honoraria for overseeing data collection for this work in Lagos, Nigeria.
Pierre Akilimali is affiliated with the Bill and Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins University and has received honoraria for overseeing data collection for this work in DRC (Kinshasa and Kongo Central).
By Shannon N. Wood, Associate Scientist in the Department of Population, Family and Reproductive Health, Johns Hopkins University And
Celia Karp, Assistant Scientist, Johns Hopkins University and
Funmilola OlaOlorun, Senior Lecturer / Honorary Consultant at the College of Medicine, University of Ibadan and
Pierre Akilimali, associate professor of medicine and public health, University of Kinshasa
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