Publicly Funded Family Planning Organizations' Response to the COVID-19 Pandemic in Texas.

INTRODUCTION: After the onset of the COVID-19 pandemic, the use of family planning services decreased, but there are limited data on how safety net providers were affected. METHODS: Between November 2020 and March 2021, we conducted in-depth interviews with administrators at health departments, federally qualified health centers, and specialized family planning organizations across Texas about pandemic-related changes in family planning services. We analyzed interview transcripts using an inductive thematic approach. RESULTS: Administrators at the 19 participating organizations described pervasive service disruptions. Some organizations closed for 6-8 weeks at the pandemic's onset owing to safety uncertainties and difficulty interpreting Texas' March 2020 executive order prohibiting "nonessential" medical services; others later suspended services after staff exposures. Health departments and federally qualified health centers commonly decreased family planning services to focus on COVID-19 response, leaving specialized family planning organizations to absorb displaced reproductive health care clients. Some of the advantages of service delivery modifications-including telehealth, curbside and drive-through prescription pickup, and medication by mail-were difficult to realize; barriers included low reimbursement, necessary patient examinations, and clients' confidentiality concerns and lack of technological resources. CONCLUSIONS: Texas' diverse network of family planning organizations illustrated a range of responses to the pandemic, and organizations often focused on their core missions-public health, primary care, or family planning.

Indirect effects of COVID-19 pandemic on reproductive, maternal, newborn and child health services in Pakistan

Background: COVID-19 is having many impacts on health, economy and social life; some due to the indirect effects of closure of health facilities to curb the spread. Closures were implemented in Pakistan from March 2020, affecting provision of reproductive, maternal, newborn and child health (RMNCH) services. Aim: To appraise the effects of containment and lockdown policies on RMNCH service utilization in order to develop an early response to avoid the catastrophic impact of COVID-19 on RMNCH in Pakistan. Methods: Routine monitoring data were analysed for indicators utilization of RMNCH care. The analysis was based on Period 1 (January–May 2020, first wave of COVID-19); Period 2 (June–September 2020, declining number of cases of COVID-19); and Period 3 (October–December 2020, second wave of COVID-19). We also compared data from May and December 2020 with corresponding months in 2019, to ascertain whether changes were due to COVID-19. Results: Reduced utilization was noted for all RMNCH indicators during Periods 1 and 3. There was a greater decline in service utilization during the first wave, and the highest reduction (~82%) was among children aged < 5 years, who were treated for pneumonia. The number of caesarean sections dropped by 57%, followed by institutional deliveries and first postnatal visit (37% each). Service utilization increased from June to September, but the second wave of COVID-19 led to another decrease. Conclusion: To reinstate routine services, priority actions and key areas include continued provision of family planning services along with uninterrupted immunization campaigns and routine maternal and child services.

Barriers in accessing family planning services in Nepal during the COVID-19 pandemic: A qualitative study.

BACKGROUND: The COVID-19 virus is still with us, and in resource-limited countries, like Nepal, resurgence of a new variant is still a threat. In this pandemic, low-income countries struggle to provide essential public health services, including family planning. This study was conducted to explore what sorts of barriers are faced by women needing family planning services in Nepal during the pandemic. METHODS: This qualitative study was conducted in five districts of Nepal. Telephonic in-depth interviews were conducted with 18 women of reproductive age (18-49 years) who were the regular clients of family planning services. Data were coded deductively using the preexisting themes based on a socio-ecological model (e.g., individual, family, community, and health-facility levels). RESULTS: Individual level barriers included low self-confidence, inadequate knowledge on COVID-19, myths and misconception related to COVID-19, limited access to FP services low priority to SRH services, low autonomy in family and limited financial ability. Family level barriers comprised of partner's support, social stigma, increased time at home with husbands or parents, un-acceptance of family planning services as essential health services, financial hardship due to loss of jobs, and communication with in-laws. Movement restrictions and transportation hindering access, unsecured feeling, violation of privacy, and obstacles from security personnel were the community level barriers and unavailability of preferred choice of contraception, increased waiting time, limited outreach services by community health workers, limited physical infrastructures, the behavior of health workers, stock out of commodities, and absence of health workers were health facility level barriers. CONCLUSION: This study highlighted key barriers faced by women in seeking family planning services during the COVID-19 lockdown in Nepal. Policymakers and program managers should consider strategies to ensure continued availability of the full method mix during emergency, particularly since disruptions may go unnoticed and strengthen the provision of services through alternative service delivery channels to ensure sustained uptake of such services in this sort of pandemic.

[Strategies for health services in women, newborns, children, and adolescents during the COVID-19 pandemic in countries of Americas]. / Estrategias de servicios de salud en mujeres, recién nacidos/as, niños/as y adolescentes durante la pandemia de COVID-19 en países de las Américas.

The article analyzes the perceived challenges and strategies implemented in five Latin American and Caribbean countries to ensure continuity of care and access to health services for women, newborns, children, and adolescents during the COVID-19 pandemic. The study corresponds to a quick assessment based on semi-structured interviews with key informants in countries selected by convenience: Colombia, Ecuador, Guatemala, Grenada, and the Dominican Republic. Interviews were conducted with 23 key informants: (a) decision makers at the national and/or subnational level, (b) healthcare professionals, and (c) representatives of civil society organizations; from December 2020 to January 2021. Among the findings, at the beginning of the pandemic, priority was given to the COVID-19 care, with measures to limit the flow of people to health facilities in the countries involved, closing or limiting outpatient visits and restricting care schedule. For women, this affected family planning services and access to contraceptive methods, implying a reduction in prenatal check-ups. As a result of this deinstitutionalization of care, among newborns, a decrease in pediatric check-ups, a decrease in timely immunization and late detection of pathologies or growth problems were reported. Among adolescents, a strong restriction of family planning services, the limitation of other friendly counseling spaces and difficulties in accessing contraceptives were observed.

El artículo analiza los desafíos percibidos y las estrategias implementadas en cinco países de América Latina y el Caribe para garantizar la continuidad de los cuidados y el acceso a servicios de salud de mujeres, recién nacidos/as, niños/as y adolescentes durante la pandemia por COVID-19. El estudio corresponde a una evaluación rápida basada en entrevistas semi-estructuradas a informantes clave de países seleccionados por conveniencia: Colombia, Ecuador, Guatemala, Granada y República Dominicana. Se realizaron entrevistas con 23 informantes clave: (a) referentes de la toma de decisión a nivel nacional y/o subnacional, (b) referentes de servicios de salud, y (c) representantes de organizaciones de la sociedad civil, durante diciembre de 2020 y enero de 2021. Entre los hallazgos, al inicio de la pandemia se priorizó la atención del COVID-19, con medidas para limitar la afluencia de personas a los establecimientos de salud en los países involucrados, procediendo al cierre o limitación de consultas externas y restricción de horarios de atención. Para las mujeres, esto impactó en los servicios de planificación familiar y el acceso a métodos anticonceptivos, e implicó una reducción de los controles prenatales. Por esta desinstitucionalización de la atención, entre recién nacidos/as fue reportada una disminución de los controles pediátricos, una disminución de su vacunación oportuna y una detección tardía de patologías o problemas de crecimiento. Entre adolescentes, se señaló una fuerte restricción de los servicios de planificación familiar, la limitación de otros espacios amigables de consejería y dificultades para acceder a anticonceptivos.

O artigo analisa os desafios observados e as estratégias implementadas em cinco países da América Latina e do Caribe para garantir a continuidade do atendimento e o acesso aos serviços de saúde para mulheres, recém-nascidos/as, crianças e adolescentes durante a pandemia de COVID-19. O estudo é uma avaliação rápida baseada em entrevistas semiestruturadas com informantes-chave em países selecionados por conveniência: Colômbia, Equador, Guatemala, Granada e República Dominicana. Foram realizadas entrevistas com 23 informantes-chave: (a) tomadores de decisão em nível nacional e/ou subnacional, (b) prestadores de serviços de saúde e (c) representantes de organizações da sociedade civil; durante dezembro de 2020 e janeiro de 2021. Entre as conclusões encontrou-se que, no início da pandemia, foi dada prioridade à COVID-19, com medidas para limitar o fluxo de pessoas às instalações de saúde nos países envolvidos, fechando ou limitando as consultas ambulatoriais e restringindo o horário de atendimento. Para as mulheres, a medida impactou os serviços de planejamento familiar e o acesso à contracepção, significando uma redução nos check-ups pré-natais. Como resultado desta desinstitucionalização dos cuidados, uma diminuição dos check-ups pediátricos, uma diminuição das vacinações no período correto e uma detecção tardia de patologias ou problemas de crescimento foram relatados entre os/as recém-nascidos/as. Entre os adolescentes, foi observada uma restrição severa dos serviços de planejamento familiar, a limitação de acesso a espaços de aconselhamento amigável e dificuldades de acesso a contraceptivos.

Where Do Reproductive-Aged Women Want to Get Contraception?

Background: People's preferences regarding how they want to obtain contraception should be considered when building and refining high-quality contraceptive care programs, especially in light of recent shifts to incorporate more telehealth options into contraceptive care due to the coronavirus disease 2019 (COVID-19) pandemic. Methods: Our study is a cross-sectional analysis of population-representative surveys conducted between November 2019 and August 2020 among women aged 18-44 years in Arizona (N = 885), New Jersey (N = 952), and Wisconsin (N = 967). We use multivariable logistic regression to identify characteristics associated with each of five contraception source preference groups (in-person via health care provider, offsite with a provider via telemedicine, offsite without a provider via telehealth, at a pharmacy, or via innovative strategies), and we examine associations between contraceptive care experiences and perceptions and each preference group. Results: Across states, most respondents (73%) expressed preferences for obtaining contraception via more than one source. One quarter indicated a narrow preference for obtaining contraception in-person from a provider, 19% expressed interest in doing so offsite with a provider via telemedicine, 64% for doing so offsite without a provider via telehealth, 71% reported interest in pharmacy-based contraception, and 25% indicated interest in getting contraception through innovative strategies. Those who had experienced nonperson-centered contraceptive counseling reported higher levels of interest in telehealth and innovative sources, and those who expressed mistrust in the contraceptive care system had higher levels of preferring to obtain contraception offsite, via telemedicine, telehealth, and other innovative avenues. Conclusions: Policies that ensure access to a diversity of contraceptive sources, which acknowledge and address people's past experiences of contraceptive care, have the greatest likelihood of closing the gap between people's contraceptive access preferences and realities.

Contraceptive services in Oregon's state-funded network during the COVID-19 pandemic.

OBJECTIVES: To understand how changes to in-person health care during the COVID pandemic impacted contraceptive use in Oregon's state-funded network. STUDY DESIGN: A retrospective cohort of 245,600 visits (virtual and in-person) among 70,295 women presenting to publicly funded family planning clinics in Oregon between January 2019 and June 2021. Data were abstracted from clinic records and restricted to visits of patients identifying as female, 12-51 years old, not using sterilization as a method. Contraception was grouped by effectiveness Tier (Tier 1: intrauterine device, implants; Tier 2: progestin injectable, pill/patch/ring). Multivariable logistic regression predicted the use of contraception by stage of the COVID pandemic which corresponded to service availability (prepandemic, acute: nonemergency services halted, subacute: restricted services), patient demographics, including insurance type, and clinic and geospatial characteristics. RESULTS: Overall during the acute stage, people with visits were more likely to leave with a method of contraception odds ratios (OR) 1.39 (95% confidence interval [CI] 1.24-1.57); however, it was significantly less likely to be a Tier 1 method (OR 0.82, 95% CI 0.74-0.91) as compared to prepandemic. This finding was particularly marked in rural areas (OR 0.69 [96% CI 0.58-0.83]) and among the publicly insured (OR 0.87 [95% CI 0.80-0.94]). CONCLUSIONS: Demand for contraception increased during the acute phase of the COVID pandemic, and shifts in method mix from Tier 1 to Tier 2 methods occurred. Disparities in contraceptive access persisted for those in rural locations or with public insurance. IMPLICATIONS: Lessons learned from the COVID-19 pandemic are critical to informing our future emergency response. The need for family planning services increased during the public health emergency.

Impact of coronavirus 19 pandemic on contraception in Jordan.

The coronavirus 19 (COVID-19) pandemic has negatively impacted family planning services worldwide. There are no published reports from Jordan on the impact of COVID-19 pandemic on family planning methods. This was a web-based cross-sectional study between September and December 2020 with 519 participants; of these 43.5% did not use any method. The most used methods were intrauterine devices, coitus interruptus and male condoms. Furthermore, 38.2% of women changed methods due to limited access to services and non-availability of methods. While 82.1% of women preferred modern methods before the pandemic, 79.7% became more acceptant of traditional methods. Moreover, 35.3% of women got pregnant during the curfew, and 90% were unplanned with a statistically significant higher rate in women who changed their routine method, accepted traditional methods, have been married for less than 10 years and multiparous women. National health policy makers should consider the impact of large-scale pandemics on family planning services.IMPACT STATEMENTWhat is already known on this subject? Family planning services in Jordan have improved significantly over the last decade because of accessibility and availability of a wide range of contraceptive methods. Available methods are either traditional or modern. Because of the high failure rates of traditional methods, public health family planning programmes promote modern methods.What do the results of this study add? There are no published reports from Jordan on the impact of COVID-19 pandemic and curfew on family planning methods. This study aims to report on what family planning methods women used during the pandemic, reporting if women changed their preferred methods and the reasons, assess women's knowledge about the natural methods of family planning which is probably an alternative method in situations where services and accessibility to more effective methods are limited and estimate unplanned pregnancies.What are the implications of these findings for clinical practice and/or further research? National health policy makers should consider the impact of large-scale pandemics on family planning services. Additionally, the implementation of telehealth and home delivery of self-administered methods should be considered. Natural methods of contraception may be an option when access and availability to modern methods is limited.

The role of partners, parents and friends in shaping young women's reproductive choices in Peri-urban Nairobi: a qualitative study.

BACKGROUND: Contraceptive use among young women in Nairobi remains low despite high general knowledge of family planning (FP) methods. This paper draws on social norms theory to explore the role of key influencers (partners, parents and friends) in women's FP use and how women anticipate normative reactions or sanctions. METHODS: A qualitative study with 16 women, 10 men and 14 key influencers across 7 peri-urban wards in Nairobi, Kenya. Interviews were conducted during the COVID-19 pandemic in 2020 by phone. A thematic analysis was conducted. RESULTS: Women identified parents, specifically mothers, aunts, partners, friends and healthcare workers as key influencers on FP. Their interactions with these key influencers varied based on trust, the information they needed about FP, and whether they perceived a key influencer to perpetuate or challenge existing social norms on FP. Mothers were perceived to understand the social risks of using FP and thus could advise on discreet FP use, and aunts were trusted and approachable sources to impartially describe the benefits and drawbacks of FP. Although women identified partners as key FP decision makers, they were cognisant of possible power imbalances affecting a final FP choice. CONCLUSIONS: FP interventions should consider the normative influence key actors have on women's FP choices. Opportunities to design and deliver network-level interventions which seek to engage with social norms surrounding FP in order to challenge misconceptions and misinformation among key influencers should be explored. Intervention design should consider dynamics of secrecy, trust and emotional closeness that mediate discussions of FP to address changing norms. Further training to change norms held by healthcare providers about why women, in particular unmarried young women, access FP should be provided to reduce barriers for FP access.

Women's decisions to use family planning (FP) are influenced by social norms, the unwritten rules of appropriate actions within social networks, and are shaped by advice and information received from key influencers­important individuals who shape what is acceptable within social networks. The aim of this study was to understand how key influencers uphold and transmit information and norms about FP, and explore who women consult as they make FP decisions and why they consult these key influencers.We interviewed 16 women, 10 partners and 14 key influencers in peri-urban Nairobi, Kenya.We found that key influencers for decisions about FP included mothers, aunts, partners, friends and healthcare providers. In making a decision about FP use, women consulted key influencers based on who they deemed trustworthy to keep their FP use secret and described less trust to speak with men about FP in their social networks. Mothers understood the social risks of using FP and so could advise on its discreet use, and aunts were approachable sources of impartial information about FP. Although women identified partners as key decision makers, they were aware that power imbalances might affect final FP choices.Our findings underscore the importance of FP interventions working with women's social networks and to address social norms influencing women's decisions in using FP. Interventions to change FP norms should consider dynamics of secrecy, trust and emotional closeness that affect FP discussions among women's networks.

Stakeholders' perceptions of family planning programs during the COVID-19 period: A descriptive qualitative study.

Aim: The number of unintended pregnancies and the decreasing use of contraceptives during the COVID-19 pandemic are of particular concern to the national population and family planning program. The successful implementation of the family planning program cannot be carried out by the government alone. Still, it requires strong synergy with stakeholders. The difference in perceptions among stakeholders, acceptors, and the community about family planning is crucial, so qualitative research is needed to identify this matter. This study explores stakeholders' perceptions of post-partum family planning programs and their barriers during the COVID-19 pandemic. Method: This research uses a descriptive qualitative method, with participants consisting of family planning officers, cadres of family planning units, and the head of the family planning program. The data were collected through in-depth interviews and examined using content analysis. Results: The results show that health workers and community leaders cooperated at the village and sub-district levels in realising the family planning programs. During the COVID-19 pandemic, services were stopped at the public health centre, especially long-term contraceptive method services. Stakeholders believe that barriers to the program's success include education level, negative perceptions, lack of training, and low trust in partners. Conclusion: Cross-sectoral engagement is essential in increasing participation in family planning programs. Other critical success factors are support from husbands, community leaders, and local government.

Adapting Family Planning Service Delivery in Title X and School-Based Settings during COVID-19: Provider and Staff Experiences.

The COVID-19 pandemic introduced urgent and unique challenges to family planning providers and staff in ensuring continued access to high-quality services, particularly for groups who experience greater barriers to accessing services, such as women with systemically marginalized identities and adolescents and young adults (AYA). While research has documented key adaptations made to service delivery during the early phase of the pandemic, limited studies have used qualitative methods. This paper draws on qualitative interview data from family planning providers and staff in Title-X-funded clinics and school-based clinics-two settings that serve populations that experience greater barriers to accessing care-to (a) describe the adaptations made to service delivery during the first year of the pandemic and (b) explore provider and staff experiences and impressions implementing these adaptations. In-depth interviews were conducted with 75 providers and staff between February 2020 and February 2021. Verbatim transcripts were analyzed via inductive content analysis followed by thematic analysis. Four key themes were identified: (1) Title-X- and school-based staff made multiple, concurrent adaptations to continue family planning services; (2) providers embraced flexibility for patient-centered care; (3) school-based staff faced unique challenges to reaching and serving youth; and (4) COVID-19 created key opportunities for innovation. The findings suggest several lasting changes to family planning service delivery and provider mindsets at clinics serving populations hardest hit by the pandemic. Future studies should evaluate promising practices in family planning service delivery-including telehealth and streamlined administrative procedures-and explore how these are experienced by diverse patient populations, particularly AYA and those in areas where privacy or internet access are limited.

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

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.

This study explored the potential impact of the COVID-19 pandemic and a 3-month government mandated lockdown on barriers to accessing family planning services in rural Uganda, and recommendations to improve service delivery in the event of future COVID-19 restrictions. Data were collected from four focus group discussions with men and women separately (N = 26) who had an unmet need for family planning, and 15 interviews with community leaders and family planning stakeholders. The delivery of family planning services was disrupted due to COVID-19, negatively affecting community members' ability to access services, such as by reducing their income. COVID-19 also disrupted community and health system distribution of services, such as through a transportation ban and the suspension of all community-based family planning delivery through village health teams and mobile clinics. Participants felt that COVID-19 lockdown restrictions worsened intimate partner violence, and with men at home more, limited women's ability to use contraceptives without their partner's knowledge and resulted in more sex between partners without women being able to refuse. Taken together, these consequences were thought to increase women's risk of unintended pregnancy. Recommendations to improve family planning service delivery in the context of COVID-19 centered on measures to improve the health system's response to emergencies and to safely deliver contraceptive methods directly to communities during future COVID-19 lockdowns. The successful implementation of community-based family planning will depend on efforts to increase men's acceptance of family planning, while addressing underlying gender inequities that diminish women's ability to time and space pregnancy.

The role of social norms on adolescent family planning in rural Kilifi county, Kenya.

PURPOSE: Despite Kenya's encouraging progress in increasing access to modern contraception among youth, several barriers remain preventing large-scale efforts to reduce demand-side unmet need for family planning. Shifting social norms around the use and acceptability of modern contraception may represent a potent target for future interventions. However, the structure of normative influence on individual modern contraceptive use among youth needs to be determined. Therefore, our aim was to estimate the influence of individual and group-level normative influence on modern contraceptive use among adolescents from two villages in rural Kenya. METHODS: Trained enumerators collected data from individuals aged 15-24 who provided oral informed consent, or parental informed consent, in two villages in rural Kilifi county. Participants completed a questionnaire related to modern contraceptive use and were asked to nominate one to five people (referents) with whom they spend free time. The enumerators photographed each individual who nominated at least one referent using Android phones and matched them with their nominated referents. Using this social network data, we estimated group-level normative influence by taking an average of referents' modern contraception use. We then explored associations between descriptive norms, injunctive norms, and network modern contraceptive use on individual modern contraceptive use, controlling for known confounders using logistic regression models. We also conducted sensitivity analyses to test a pattern of differential referent influence on individual modern contraceptive use. RESULTS: There was a positive association between pro-modern contraception descriptive and injunctive norms and individual modern contraception use (adjusted Odds Ratio (aOR) = 1.29, 95% confidence interval (CI) = 1.05-1.6, and aOR = 1.31, CI = 1.06-1.62, respectively). Network modern contraceptive use was associated with individual use in the bivariate model (aOR = 2.57, CI = 1.6-4.12), but not in the multivariable model (aOR = 1.67, CI = 0.98-2.87). When stratified by sex and marital status, network modern contraceptive use was associated with individual modern contraceptive use among female participants (aOR = 2.9, CI = 1.31-6.42), and unmarried female participants (aOR = 5.26, CI = 1.34-20.69), but not among males. No interactive effects between norms variables were detected. Sensitivity analyses with a different estimate of network modern contraceptive use showed similar results. CONCLUSIONS: Social norms are multilevel phenomena that influence youth modern contraceptive use, especially among young women in rural Kenya. Unmarried women with modern contraceptive users in their social network may feel less stigma to use contraception themselves. This may reflect gendered differences in norms and social influence effects for modern contraceptive use. Future research should investigate group-level normative influence in relation to family planning behaviors.

The psychological burden of COVID-19 on the desire for parenthood in minoritized sexual identities: a study on depressive symptoms and family planning in Germany.

BACKGROUND: The COVID-19 pandemic continues to spread across the globe and is associated with significant clinical and humanitarian burden. The desire for parenthood has been described to be positively correlated with psychological well-being: An unfulfilled wish for parenthood is associated with impaired mental health, and the wish for parenthood is a predictor for the development of depressive symptoms. While higher rates of anxiety and depression have been reported in individuals with minoritized sexual identities (compared to heterosexual individuals) during the COVID-19 pandemic, the specific impact of the pandemic and its social restriction measures on this population is poorly understood. METHODS: From April to July 2020, we conducted an anonymous cross-sectional survey online among N = 2463 adults living in Germany. We screened for depressive symptoms (Patient Health Questionnaire-4; PHQ-4) and assessed individuals' desire for parenthood during the pandemic, and motives for or against the desire for parenthood (Leipzig questionnaire on motives for having a child, Version 20; LKM-20), with the aim of identifying differences between individuals with minoritized sexual identities and heterosexual individuals. RESULTS: Compared to heterosexual individuals (n = 1304), individuals with minoritized sexual identities (n = 831) indicated higher levels of depressive symptoms. In our study sample the majority of all participants (81.9%) reported no change in the desire for parenthood since the COVID-19 pandemic. CONCLUSION: The findings underline the unmet need for social, psychological and medical support in regard to family-planning and the desire for parenthood during a pandemic. Furthermore, future research should explore COVID-19-related psychological consequences on individuals' desire for parenthood and building a family.

Determinant Factors of Post-Partum Contraception among Women during COVID-19 in West Java Province, Indonesia.

BACKGROUND: One of the manifestations of family development is pregnancy planning, where this method is applied 0-42 days after childbirth. Post-partum contraception is an effort to avoid pregnancy by using contraceptive medicine from 42 days to 84 days after childbirth. PURPOSE: This research aims to analyze the attitudes of fertile couples who use contraceptive devices after childbirth during the COVID-19 pandemic and the factors that influence it. METHOD: This research uses a quantitative method approach. The sampling technique was random sampling with proportional sampling so that 280 respondents were obtained from 3 regencies/cities in West Java with high fertility rates and low post-partum contraceptive participation rates. Quantitative data analysis used univariate, bivariate, and multivariate methods. RESULT: The results showed that the final model of the analysis of the most determining factors for post-partum contraception during a pandemic were family support, healthcare staff support, counselling with healthcare staff, attitudes, and age at first marriage. CONCLUSION: Fertile couples with the highest amount of family support are more likely to use post-partum contraceptive devices during COVID-19. The results of this study can be used as material for consideration in making decisions about post-partum contraception, especially during the COVID-19 pandemic.

Disruptions in Accessing Women's Health Care Services: Evidence Using COVID-19 Health Services Disruption Survey.

INTRODUCTION: The world is experiencing the Coronavirus pandemic and the aftermath consequences leading to lockdown and travel restrictions. The pandemic has brought a far-reaching impact on various sectors, including the economic, and health sectors. Therefore, this study analyses the possible impact of the COVID-19 pandemic on the disruption - in accessing family planning measures i.e. contraception facilities; and in seeking help from women organizations for health services. METHODS: This study has used the COVID-19 health services disruption survey-2020 and data was obtained from the Institute of Health Metrics and Evaluation. This survey was conducted in 76 countries using the smartphone-based premise data collection platform. Respondents were individual members of the general population ages 15-49 years who were identified as women. Data were collected from 12,354 respondents. Our data analysis has been done on both aggregate samples as well as region-wise samples (i.e. Africa, Asia, Europe, and Latin America & the Caribbean) to assess the change in levels of service delivery in both pre-COVID and post-COVID periods. RESULTS: Descriptive statistics results shows that two particular reasons - unable to access due to lockdown restrictions (5.4%), and fear of being infected with COVID-19 (9.7%) were reported as mostly impacting the access to contraception facilities due to lockdown restriction. Further, the logit regression using socio-economic and demographic variables suggests that geographical location (rural), and poor financial status turned out negative and significant, showing higher odds of facing difficulty than the reference category for the aggregate sample. The region-wise analysis suggests that Europe and Asia are the regions with the highest percentage of respondents reporting unavailability of services during COVID-19. CONCLUSION: The study concludes that pandemic-related emergencies affect the health care system, especially women-related health care services. The implication of our study indicates the requirement of a supply chain strategy for managing health care demand during emerging situations. So, the disruptions and bottlenecks in health care facilities should be addressed by various governments through appropriate policies and interventions.

Trends in fertility intentions and contraceptive practices in the context of COVID-19 in sub-Saharan Africa: insights from four national and regional population-based cohorts.

OBJECTIVES: Studies in several sub-Saharan geographies conducted early in the COVID-19 pandemic suggested little impact on contraceptive behaviours. Initial results may mask widening disparities with rising poverty, and changes to women's pregnancy desires and contraceptive use amid prolonged health service disruptions. This study examined trends in contraceptive behaviours in four sub-Saharan African settings 1 year into the pandemic. DESIGN: Nationally and regionally representative longitudinal surveys. SETTING: Burkina Faso, Kenya, Democratic Republic of Congo (Kinshasa) and Nigeria (Lagos). PARTICIPANTS: Women aged 15-49 years with sample size ranging from 1469 in Nigeria to 9477 in Kenya. OUTCOME MEASURES: Fertility preferences, contraceptive use and unintended pregnancies measured before COVID-19 (November 2019 to January 2020) and during COVID-19 (November 2020 to January 2021). ANALYSIS: We described population-level and individual-level changes by socioeconomic characteristics using generalised equation modelling. We used logistic regression models to identify factors related to contraceptive adoption and discontinuation and to experiencing an unintended pregnancy. RESULTS: At the population level, we found no change in women's exposure to unintended pregnancy risk, alongside 5-9 percentage point increases in contraceptive prevalence in Burkina Faso, Kenya and Lagos. Reliance on provider-dependent methods dropped by 2 and 4 percentage points in Kenya and Burkina Faso, respectively, although these declines were not statistically significant. Between 1.0% and 2.8% of women across sites experienced an unintended pregnancy during COVID-19, with no significant change over time. Individual-level trajectories showed contraceptive adoption was more common than discontinuation in Burkina Faso, Kenya and Lagos, with little difference by sociodemographic characteristics. Women's COVID-19-related economic vulnerability was unrelated to unintended pregnancy across sites. CONCLUSIONS: This study highlights the resilience of African women across diverse settings in sustaining contraceptive practices amid the COVID-19 pandemic. However, with reports of rising poverty in sub-Saharan Africa, there is continued need to monitor access to essential sexual and reproductive health services.

Changes in the Clinical Workforce Providing Contraception and Abortion Care in the US, 2019-2021.

This cross-sectional study investigates changes in the workforce providing contraception and abortion services from before to during the COVID-19 pandemic.

Assessing differences in contraceptive provision through telemedicine among reproductive health providers during the COVID-19 pandemic in the United States.

BACKGROUND: Providers faced challenges in maintaining patient access to contraceptive services and public health safety during the COVID-19 pandemic. Due to increased barriers to care, providers increasingly used telemedicine for contraceptive care, curbside services, mail-order pharmacies, and on-line or home delivery of contraceptive methods, including self-administration of subcutaneous depo medroxyprogesterone acetate (DMPA-SQ). To better understand how reproductive health providers adapted service provision during the pandemic, this study assessed clinical practice changes and strategies providers adopted throughout the United States to maintain contraceptive care, particularly when clinics closed on-site, and the challenges that remained in offering contraceptive services, especially to marginalized patient populations. METHODS: We surveyed U.S. providers and clinic staff (n = 907) in April 2020-January 2021, collecting data on contraceptive service delivery challenges and adaptations, including telemedicine. We assessed clinical practice changes with multivariate regression analyses using generalized linear models with a Poisson distribution and cluster robust standard errors, adjusting for clinic patient volume, practice setting, region, Title X funding, and time of survey. RESULTS: While 80% of providers reported their clinic remained open, 20% were closed on-site. Providers said the pandemic made it more difficult to offer the full range of contraceptive methods (65%), contraceptive counseling (61%) or to meet the needs of patients in marginalized communities (50%). While only 11% of providers offered telemedicine pre-pandemic, most offered telemedicine visits (79%) during the pandemic. Some used mail-order pharmacies (35%), curbside contraceptive services (22%), and DMPA-SQ for self-administration (10%). Clinics that closed on-site were more likely to use mail-order pharmacies (aRR 1.83, 95% CI [1.37-2.44]) and prescribe self-administered DMPA-SQ (aRR 3.85, 95% CI [2.40-6.18]). Clinics closed on-site were just as likely to use telemedicine as those that remained open. Among clinics using telemedicine, those closed on-site continued facing challenges in contraceptive service provision. CONCLUSIONS: Clinics closing on-site were just as likely to offer telemedicine, but faced greater challenges in offering contraceptive counseling and the full range of contraceptive methods, and meeting the needs of marginalized communities. Maintaining in-person care for contraceptive services, in spite of staffing shortages and financial difficulties, is an important objective during and beyond the pandemic.