Stability and change in fertility intentions in response to the COVID-19 pandemic in Kenya

Fertility intentions are expected to decline due to the COVID-19 pandemic but limited empirical research on this topic has been conducted in sub-Saharan Africa. Longitudinal data from Kenya, with baseline (November 2019) and follow-up (June 2020) data, were used to 1) assess the extent to which individual-level fertility intentions changed, and 2) examine how security, specifically economic and health security, affected fertility intentions. The final sample included 3,095 women. The primary outcomes were change in quantum and timing. Exploratory analyses described overall changes within the sample and logistic regression models assessed sociodemographic and COVID-19 related correlates of change, specifically income loss at the household level, food insecurity, and ability to socially distance. Approximately 85% of women reported consistent fertility intentions related to both the number and timing of childbearing. No COVID-19-related factors were related to changing quantum intentions. Women who reported chronic food insecurity had 4.78 times the odds of accelerating their desired timing to next birth compared to those who reported no food insecurity (95% CI: 1.53–14.93), with a significant interaction by wealth. The COVID-19 pandemic did not lead to widespread changes in fertility intentions in Kenya, though the most vulnerable women may have accelerated their childbearing intentions.

An exploratory study of COVID-19-related changes in abortion service availability and use in Washington, DC, Maryland, and Virginia.

OBJECTIVES: This exploratory study aimed to assess COVID-19-related changes in abortion service availability and use in Washington, DC, Maryland, and Virginia. DESIGN: Data came from a convenience sample of eight abortion clinics in this region. We implemented a cross-sectional survey and collected retrospective aggregate monthly abortion data overall and by facility type, abortion type, and patient characteristics for March 2019-August 2020. We evaluated changes in the distribution of the total number of patients for March-August in 2019 compared to March-August 2020. We also conducted segmented regression analyses and produced scatter plots of monthly abortion patients overall and by facility type, abortion type, and patient characteristics, with separate fitted regression lines from the segmented regression models for the pre- and during-COVID-19 periods. RESULTS: Five clinics reported a reduced number of appointments early in the pandemic while four reported increased call volume. There were declines in the monthly abortion trend at hospital-based clinics at the outset of the pandemic. Monthly number of medication abortions increased from March 2020 through August 2020 compared to pre-COVID-19 trends while instrumentation abortions 11 up to 19 weeks decreased. The share of abortions to Black individuals increased during the early phase of the pandemic, as did the monthly trend in abortions among this group. We also saw changes in payment type, with declines in patients paying out-of-pocket. CONCLUSIONS: Results revealed differences in abortion services, numbers, and types during the early stages of the COVID-19 pandemic in Washington, DC, Maryland, and Virginia.

COVID-19 impacts on abortion care-seeking experiences in the Washington, DC, Maryland, and Virginia regions of the United States.

CONTEXT: Many people wanted to avoid or delay childbearing during the COVID-19 pandemic. This study sought to examine the extent COVID-19 influenced abortion care-seeking in a region that did not enact policy restricting abortion due to the pandemic, has high service availability, and few abortion-restrictive policies. METHODOLOGY: We conducted telephone surveys with adults (n=72) requesting abortion appointments between September 2020 and March 2021 at five clinics in Washington, DC, Maryland, and Virginia. We used χ2 tests to compare sociodemographic, reproductive history, service delivery characteristics, and pandemic-related life changes by whether COVID-19 influenced abortion care-seeking. RESULTS: Most respondents (93%) had an abortion at the time of the survey, 4% were awaiting their scheduled appointment, and 3% did not have an appointment scheduled. Nearly 40% of people reported COVID-19 influenced their decision to have an abortion. These individuals were significantly more likely to report "not financially prepared" (44% vs. 16%) as a reason for termination compared to people reporting no influence of COVID-19. They were also more likely to have lost or changed their health insurance due to pandemic-related employment changes (15% vs. 2%), report substantial money difficulties due to COVID-19 (59% vs. 33%), and report that paying for their abortion was "very difficult" (25% vs. 2%). CONCLUSION: COVID-19 influenced many people to have an abortion, particularly those financially disadvantaged by the pandemic. Expansion of Medicaid abortion coverage in Washington, DC and Virginia could reduce financial barriers to care and help people to better meet their reproductive needs amid future crises.

Stability and change in fertility intentions in response to the COVID-19 pandemic in Kenya.

Fertility intentions are expected to decline due to the COVID-19 pandemic but limited empirical research on this topic has been conducted in sub-Saharan Africa. Longitudinal data from Kenya, with baseline (November 2019) and follow-up (June 2020) data, were used to 1) assess the extent to which individual-level fertility intentions changed, and 2) examine how security, specifically economic and health security, affected fertility intentions. The final sample included 3,095 women. The primary outcomes were change in quantum and timing. Exploratory analyses described overall changes within the sample and logistic regression models assessed sociodemographic and COVID-19 related correlates of change, specifically income loss at the household level, food insecurity, and ability to socially distance. Approximately 85% of women reported consistent fertility intentions related to both the number and timing of childbearing. No COVID-19-related factors were related to changing quantum intentions. Women who reported chronic food insecurity had 4.78 times the odds of accelerating their desired timing to next birth compared to those who reported no food insecurity (95% CI: 1.53-14.93), with a significant interaction by wealth. The COVID-19 pandemic did not lead to widespread changes in fertility intentions in Kenya, though the most vulnerable women may have accelerated their childbearing intentions.

Contraceptive dynamics during COVID-19 in sub-Saharan Africa: longitudinal evidence from Burkina Faso and Kenya.

INTRODUCTION: Evidence from health emergencies suggests COVID-19 will disrupt women's sexual and reproductive health (SRH). In sub-Saharan Africa, which experiences the highest rates of unintended pregnancy and unsafe abortion globally, COVID-19 is projected to slow recent progress toward universal access to contraceptive services. METHODS: We used longitudinal data collected from women at risk of unintended pregnancy in Burkina Faso (n=1186) and Kenya (n=2784) before (November 2019-February 2020) and during (May-July 2020) COVID-19 to quantify contraceptive dynamics during COVID-19; examine sociodemographic factors and COVID-19 experiences related to contraceptive dynamics; and assess COVID-19-related reasons for contraceptive non-use. Bivariate and multivariate logistic regressions were used to examine correlates of contraceptive dynamics amid COVID-19. RESULTS: Most women did not change their contraceptive status during COVID-19 (68.6% in Burkina Faso and 81.6% in Kenya) and those who did were more likely to adopt a method (25.4% and 13.1%, respectively) than to discontinue (6.0% and 5.3%, respectively). Most women who switched contraceptives were using methods as or more effective than their pre-pandemic contraception. Economic instability related to COVID-19 was associated with increased contraceptive protection in Burkina Faso but not in Kenya. Altogether, 14.4% of non-contraceptive users in Kenya and 3.8% in Burkina Faso identified COVID-19-related reasons for non-use. CONCLUSIONS: The vast majority of women at risk of unintended pregnancy did not change their contraceptive status during COVID-19, and more women adopted than discontinued methods. A minority of women reported COVID-19-related reasons for non-use, underscoring the importance of expanding safe modes of service delivery during health crises.