Exploring the effects of COVID-19 on family planning: results from a qualitative study in rural Uganda following COVID-19 lockdown

Katelyn M Sileo, Christine Muhumuza, Teddy Helal, Allison Olfers, Haruna Lule, Samuel Sekamatte, Trace S Kershaw, Rhoda K Wanyenze, Susan M Kiene, Katelyn M Sileo, Christine Muhumuza, Teddy Helal, Allison Olfers, Haruna Lule, Samuel Sekamatte, Trace S Kershaw, Rhoda K Wanyenze, Susan M Kiene

Abstract

Background: The COVID-19 pandemic has likely affected the already high unmet need for family planning in low- and middle-income countries. This qualitative study used Andersen's Behavioral Model of Health Service Use as a theoretical framework to explore the possible ways in which the COVID-19 pandemic, including the impact of a 3-month government mandated lockdown, might affect family planning outcomes in rural Uganda. A secondary aim was to elicit recommendations to improve family planning service delivery in the context of COVID-19.

Methods: Between June and October 2020, we conducted four focus group discussions with men and women separately (N = 26) who had an unmet need for family planning, and 15 key-informant interviews with community leaders and family planning stakeholders. Data were analyzed using thematic analysis.

Results: We identified a significant disruption to the delivery of family planning services due to COVID-19, with potential negative effects on contraceptive use and risk for unintended pregnancy. COVID-19 had a negative effect on individual enabling factors such as family income, affecting service access, and on community enabling factors, such as transportation barriers and the disruption of community-based family planning delivery through village health teams and mobile clinics. Participants felt COVID-19 lockdown restrictions exacerbated existing contextual predisposing factors related to poverty and gender inequity, such as intimate partner violence and power inequities that diminish women's ability to refuse sex with their husband and their autonomy to use contraceptives. Recommendations to improve family planning service delivery in the context of COVID-19 centered on emergency preparedness, strengthening community health systems, and creating new ways to safely deliver contractive methods directly to communities during future COVID-19 lockdowns.

Conclusions: This study highlights the consequences of COVID-19 lockdown on family planning distribution, as well as the exacerbation of gender inequities that limit women's autonomy in pregnancy prevention measures. To improve family planning service uptake in the context of COVID-19, there is a need to strengthen emergency preparedness and response, utilize community structures for contraceptive delivery, and address the underlying gender inequities that affect care seeking and service utilization.

Keywords: COVID-19; Family planning services; Qualitative; Uganda.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2023. The Author(s).

Figures

Fig. 1
Fig. 1
The Anderson Behavioral Model of Health Service Utilization applied to the exploration of COVID-19’s effect on barriers and facilitators to family planning service utilization
Fig. 2
Fig. 2
Study findings mapped onto the Anderson Behavioral Model of Health Service Utilization

References

    1. Riley T, Sully E, Ahmed Z, et al. Estimates of the potential impact of the COVID-19 pandemic on sexual and reproductive health in low- and middle-income countries. Int Perspect Sex Reprod Health. 2020;16(46):73–76. doi: 10.1363/46e9020.
    1. UNFPA. Impact of COVID-19 on Family Planning: What we know one year into the pandemic. UNFPA. . Accessed Nov 2021.
    1. Central Intelligence Agency. The World Factbook. Country Comparison: Total Fertility Rate. . Accessed Nov 2021.
    1. WHO, UNICEF, UNFPA, et al. Trends in Maternal Mortality: 2000 to 2017. Geneva: World Health Organization
    1. FP2020. Uganda—FP2020 core indicator summary sheet: 2018–2019 Annual Progress Report. . Accessed Nov 2021.
    1. World Health Organization. WHO COVID-19 dashboard. World Health Organization. . Accessed Nov 2021.
    1. Bongomin F, Olum R, Andia-Biraro I, et al. COVID-19 vaccine acceptance among high-risk populations in Uganda. Ther Adv Infect Dis. 2021 doi: 10.1177/20499361211024376.
    1. Ministry of Health, Republic of Uganda. Update on the response to COVID-19 pandemic. Accessed 30 Jun 2021.
    1. Dasgupta A, Kantorová V, Ueffing P. The impact of the COVID-19 crisis on meeting needs for family planning: a global scenario by contraceptive methods used. Gates Open Res. 2020;4:102. doi: 10.12688/gatesopenres.13148.2.
    1. Church K, Gassner J, Elliott M. Reproductive health under COVID-19—challenges of responding in a global crisis. Sex Reprod Health Matters. 2020; 28(1):1–3.
    1. Sharma V, De Beni D, Sachs Robertson A, et al. Why the promotion of family planning makes more sense now than ever before? J Health Manag. 2020;22(2):206–214. doi: 10.1177/0972063420935545.
    1. Bolarinwa OA. Factors associated with limited access to condoms and sources of condoms during the COVID-19 pandemic in South Africa. Arch Public Health. 2021;79(1):186. doi: 10.1186/s13690-021-00701-5.
    1. Assefa N, Sié A, Wang D, et al. Reported barriers to healthcare access and service disruptions caused by COVID-19 in Burkina Faso, Ethiopia, and Nigeria: a telephone survey. Am J Trop Med Hyg. 2021;105(2):323–330. doi: 10.4269/ajtmh.20-1619.
    1. Sseninde J, Kabagenyi A, Kyadondo B, et al. Analysis of the prevalence of the preferred methods of contraception during the COVID 19 lockdown in Uganda: a multinomial logistic regression study. Res Square. 2021 doi: 10.21203/-635015/v1.
    1. Li G, Tang D, Song B, et al. Impact of the COVID-19 pandemic on partner relationships and sexual and reproductive health: cross-sectional, online survey study. J Med Internet Res. 2020;22(8):e20961. doi: 10.2196/20961.
    1. Karp C, Wood SN, Guiella G, et al. Contraceptive dynamics during COVID-19 in sub-Saharan Africa: longitudinal evidence from Burkina Faso and Kenya. BMJ Sex Reprod Health. 2021;47(4):252–260. doi: 10.1136/bmjsrh-2020-200944.
    1. VanBenschoten H, Kuganantham H, Larsson EC, et al. Impact of the COVID-19 pandemic on access to and utilisation of services for sexual and reproductive health: a scoping review. BMJ Glob Health. 2022 doi: 10.1136/bmjgh-2022-009594.
    1. Cousins S. Violence and community mistrust hamper Ebola response. Lancet Infect Dis. 2018;18(12):1314–1315. doi: 10.1016/S1473-3099(18)30658-3.
    1. Kriel Y, Milford C, Cordero J, et al. Male partner influence on family planning and contraceptive use: perspectives from community members and healthcare providers in KwaZulu-Natal, South Africa. Reprod Health. 2019;16(1):89. doi: 10.1186/s12978-019-0749-y.
    1. Sileo KM, Wanyenze RK, Lule H, et al. Determinants of family planning service uptake and use of contraceptives among postpartum women in rural Uganda. Int J Public Health. 2015;60(8):987–997. doi: 10.1007/s00038-015-0683-x.
    1. Silverman JG, Challa S, Boyce SC, et al. Associations of reproductive coercion and intimate partner violence with overt and covert family planning use among married adolescent girls in Niger. EClinicalMedicine. 2020;22:100359. doi: 10.1016/j.eclinm.2020.100359.
    1. Bradbury-Jones C, Isham L. The pandemic paradox: the consequences of COVID-19 on domestic violence. J Clin Nurs. 2020;29(13–14):2047–2049. doi: 10.1111/jocn.15296.
    1. Andersen R. A behavioral model for families' use of health services. Center for Health Administration Studies Research Series. Chicago: University of Chicago Press; 1968.
    1. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10. doi: 10.2307/2137284.
    1. Andersen RMNJ. Social and individual determinants of medical care utilization in the United States. Milbank Meml Q. 1973;51:95–124. doi: 10.2307/3349613.
    1. Babitsch B, Gohl D, von Lengerke T. Re-revisiting andersen's behavioral model of health services use: a systematic review of studies from 1998–2011. Psychosoc Med. 2012;9:Doc11.
    1. Andersen RM, Davidson PL. Improving access to care in America: individual and contextual indicators. In: Andersen RM, Rice TH, Kominski EF, editors. Changing the U.S. health care system: key issues in health services, policy, and management. San Francisco: Jossey-Bass; 2001. pp. 3–30.
    1. Olika AK, Kitila SB, Terfa YB, et al. Contraceptive use among sexually active female adolescents in Ethiopia: trends and determinants from national demographic and health surveys. Reprod Health. 2021;18(1):104. doi: 10.1186/s12978-021-01161-4.
    1. Asiimwe JB, Ndugga P, Mushomi J, et al. Factors associated with modern contraceptive use among young and older women in Uganda; a comparative analysis. BMC Public Health. 2014;14:926–926. doi: 10.1186/1471-2458-14-926.
    1. Sileo KM, Wanyenze RK, Lule H, et al. "That would be good but most men are afraid of coming to the clinic": men and women's perspectives on strategies to increase male involvement in women's reproductive health services in rural Uganda. J Health Psychol. 2017;22(12):1552–1562. doi: 10.1177/1359105316630297.
    1. Thummalachetty N, Mathur S, Mullinax M, et al. Contraceptive knowledge, perceptions, and concerns among men in Uganda. BMC Public Health. 2017;17(1):792. doi: 10.1186/s12889-017-4815-5.
    1. Mutumba M, Wekesa E, Stephenson R. Community influences on modern contraceptive use among young women in low and middle-income countries: a cross-sectional multi-country analysis. BMC Public Health. 2018;18(1):430. doi: 10.1186/s12889-018-5331-y.
    1. Kabagenyi A, Jennings L, Reid A, et al. Barriers to male involvement in contraceptive uptake and reproductive health services: a qualitative study of men and women’s perceptions in two rural districts in Uganda. Reprod Health. 2014;11(1):21. doi: 10.1186/1742-4755-11-21.
    1. Dereje GN. Femininity, masculinity and family planning decision-making among married men and women in rural Ethiopia: a qualitative study. J Afr Stud Devel. 2018 doi: 10.5897/JASD2018.0498.
    1. Nakyazze B. Intimate partner violence during the COVID-19 pandemic: an impending public health crisis in Africa. Anatolian J Fam Med. 2020;3:92–95.
    1. Sserwanja Q, Musaba MW, Mukunya D. Prevalence and factors associated with modern contraceptives utilization among female adolescents in Uganda. BMC Womens Health. 2021;21(1):61. doi: 10.1186/s12905-021-01206-7.
    1. Tessema GA, Streak Gomersall J, Mahmood MA, et al. Factors determining quality of care in family planning services in Africa: a systematic review of mixed evidence. PLoS ONE. 2016;11(11):e0165627. doi: 10.1371/journal.pone.0165627.
    1. Ezeh AC, Kodzi I, Emina J. Reaching the urban poor with family planning services. Stud Fam Plann. 2010;41(2):109–116. doi: 10.1111/j.1728-4465.2010.00231.x.
    1. Bakeera SK, Wamala SP, Galea S, et al. Community perceptions and factors influencing utilization of health services in Uganda. Int J Equity Health. 2009;8:25. doi: 10.1186/1475-9276-8-25.
    1. Boyatzis RE. Transforming qualitative information: Thematic analysis and code development. Thousand Oaks: Sage; 1998.
    1. Zapata LB, Curtis KM, Steiner RJ, et al. COVID-19 and family planning service delivery: findings from a survey of U.S. physicians. Prev Med. 2021;150:106664. doi: 10.1016/j.ypmed.2021.106664.
    1. High Impact Practices in Family Planning. Family planning high impact practices list. Washington, DC: USAID; 2019. . Accessed Nov 2021.
    1. Mickler AK, Carrasco MA, Raney L, et al. Applications of the high impact practices in family planning during COVID-19. Sex Reprod Health Matters. 2021; 29(1):1881210–1881210. doi: 10.1080/26410397.2021.1881210.
    1. Weinberger M, Hayes B, White J, et al. Doing things differently: What it would take to ensure continued access to contraception During COVID-19. Glob Health Sci Pract. 2020;8(2):169–175. doi: 10.9745/GHSP-D-20-00171.
    1. World health Organization. Maintaining essential health services: operational guidance for the COVID-19 context interim guidance. Geneva: WHO. 2020. . Accessed Nov 2021.
    1. Meyer D, Bishai D, Ravi SJ, et al. A checklist to improve health system resilience to infectious disease outbreaks and natural hazards. BMJ Glob Health. 2020;5(8):e002429. doi: 10.1136/bmjgh-2020-002429.
    1. Lal A, Ashworth HC, Dada S, et al. Optimizing pandemic preparedness and response through health information systems: lessons learned from Ebola to COVID-19. Disaster Med Public Health Prep. 2020 doi: 10.1017/dmp.2020.361.
    1. Miller NP, Milsom P, Johnson G, et al. Community health workers during the Ebola outbreak in Guinea, Liberia, and Sierra Leone. J Glob Health. 2018;8(2):020601. doi: 10.7189/jogh-08-020601.
    1. Belaid L, Dumont A, Chaillet N, et al. Effectiveness of demand generation interventions on use of modern contraceptives in low- and middle-income countries. Trop Med Int Health. 2016;21(10):1240–1254. doi: 10.1111/tmi.12758.
    1. Phiri M, King R, Newell JN. Behaviour change techniques and contraceptive use in low and middle income countries: a review. Reprod Health. 2015;12:100. doi: 10.1186/s12978-015-0091-y.
    1. Adelekan A, Omoregie P, Edoni E. Male involvement in family planning: challenges and way forward. Int J Popul Res. 2014;2014:1–9. doi: 10.1155/2014/416457.
    1. Sánchez OR, Vale DB, Rodrigues L, et al. Violence against women during the COVID-19 pandemic: an integrative review. Int J Gynaecol Obstet. 2020;151(2):180–187. doi: 10.1002/ijgo.13365.
    1. Bambra C, Riordan R, Ford J, et al. The COVID-19 pandemic and health inequalities. J Epidemiol Community Health. 2020;74:964–968.
    1. Institute for Reproductive Health . Male Engagement in family planning: Reducing unmet need for family planning by addressing gender norms. Washington: IRH, USAID, Tekponon Jikuagou; 2014.
    1. High-Impact Practices in Family Planning (HIPs). Engaging men and boys in family planning: a strategic planning guide. Washington, DC; USAID. 2016. . Accessed Nov 2021.
    1. Tokhi M, Comrie-Thomson L, Davis J, et al. Involving men to improve maternal and newborn health: a systematic review of the effectiveness of interventions. PLoS ONE. 2018;13(1):e0191620. doi: 10.1371/journal.pone.0191620.
    1. Barker G, Ricardo C, Nascimento M. Engaging men and boys in changing gender based inequity in health: evidence from programme interventions. Geneva: WHO; 2007.
    1. Hartmann M, Gilles K, Shattuck D, et al. Changes in couples' communication as a result of a male-involvement family planning intervention. J Health Commun. 2012;17(7):802–819. doi: 10.1080/10810730.2011.650825.
    1. Shattuck D, Kerner B, Gilles K, et al. Encouraging contraceptive uptake by motivating men to communicate about family planning: the Malawi Male Motivator Project. Am J Public Health. 2011;101(6):1089–1095. doi: 10.2105/AJPH.2010.300091.
    1. Schuler SR, Nanda G, Ramirez LF, et al. Interactive workshops to promote gender equity and family planning in rural Guatemalan Communities: results of a community randomized trial. J Biosoc Sci. 2015;47(5):667–686. doi: 10.1017/S0021932014000418.
    1. MacDonald L, Jones L, Thomas P, et al. Promoting male involvement in family planning in Vietnam and India: HealthBridge experience. Gend Dev. 2013;21(1):31–45. doi: 10.1080/13552074.2013.767498.
    1. Avogo W, Agadjanian V. Men's social networks and contraception in Ghana. J Biosoc Sci. 2008;40(3):413–429. doi: 10.1017/S0021932007002507.
    1. Doyle K, Levtov RG, Barker G, et al. Gender-transformative Bandebereho couples' intervention to promote male engagement in reproductive and maternal health and violence prevention in Rwanda: findings from a randomized controlled trial. PLoS ONE. 2018;13(4):e0192756. doi: 10.1371/journal.pone.0192756.
    1. Wegs C, Creanga AA, Galavotti C, et al. Community dialogue to shift social norms and enable family planning: an evaluation of the family planning results initiative in Kenya. PLoS ONE. 2016;11(4):e0153907. doi: 10.1371/journal.pone.0153907.
    1. Wouters OJ, Shadlen KC, Salcher-Konrad M, et al. Challenges in ensuring global access to COVID-19 vaccines: production, affordability, allocation, and deployment. Lancet. 2021;397(10278):1023–1034. doi: 10.1016/S0140-6736(21)00306-8.

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