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2.
Obstet Gynecol ; 138(4): 574-577, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1462516

ABSTRACT

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, health care professionals have made swift accommodations to provide consistent and safe care, including emphasizing remote access to allow physical distancing. Depot medroxyprogesterone acetate intramuscular injection (DMPA-IM) prescription is typically administered by a health care professional, whereas DMPA-subcutaneous has the potential to be safely self-injected by patients, avoiding contact with a health care professional. However, DMPA-subcutaneous is rarely prescribed despite its U.S. Food and Drug Administration approval in 2004 and widespread coverage by both state Medicaid providers and many private insurers. Depot medroxyprogesterone acetate users are disproportionately non-White, and thus the restriction in DMPA-subcutaneous prescribing may both stem from and contribute to systemic racial health disparities. We review evidence on acceptability, safety, and continuation rates of DMPA-subcutaneous, consider sources of implicit bias that may impede prescription of this contraceptive method, and provide recommendations for implementing DMPA-subcutaneous prescribing.


Subject(s)
COVID-19 , Contraceptive Agents, Female/administration & dosage , Family Planning Services/statistics & numerical data , Medroxyprogesterone Acetate/administration & dosage , Patient Acceptance of Health Care/statistics & numerical data , Contraception/statistics & numerical data , Drug Prescriptions/statistics & numerical data , Family Planning Services/methods , Female , Health Services Accessibility/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Humans , Injections, Subcutaneous , SARS-CoV-2 , Self Administration , United States
3.
Sci Rep ; 11(1): 16310, 2021 08 11.
Article in English | MEDLINE | ID: covidwho-1354118

ABSTRACT

The coronavirus disease (COVID-19) has already been declared a global pandemic. To our knowledge, there is very little information regarding the effects of COVID-19 on women seeking reproductive health services, specifically abortion. This study was aimed to assess the impact of the COVID-19 pandemic on reproductive and sexual health among women seeking abortion services. We conducted a series of preliminary analyses using data collected from ten maternal and child health hospitals of seven provinces in China before and during the COVID-19 lockdown. The present study showed that a significant decrease was observed in the frequency of sexual intercourse during the COVID-19 pandemic. Moreover, a significant increase in contraceptive use including condom, rhythm method and coitus interruptus whereas a decrease in choosing oral contraceptives were observed during the COVID-19 pandemic. In addition, the pandemic was associated with increased intention of seeking induced abortion due to social factors. Future research should look into the long-term impact of the COVID-19 pandemic on sexual and reproductive health.


Subject(s)
Abortion, Induced , COVID-19/physiopathology , Reproduction , Sexual Health , Adolescent , Adult , Cohort Studies , Contraception/statistics & numerical data , Female , Humans , Middle Aged , Prospective Studies , Sexual Behavior , Young Adult
4.
BMJ Open Qual ; 10(Suppl 1)2021 07.
Article in English | MEDLINE | ID: covidwho-1341328

ABSTRACT

BACKGROUND: Unintended pregnancies have a negative impact on the health and economy of a nation, which can be prevented by effective family planning (FP) services. Postpartum intrauterine device (PPIUCD) is a safe and effective FP method which allows women to obtain long-acting contraception before discharge from the point of delivery. We observed poor coverage of deliveries with PPIUCD at our facility. This was the trigger to initiate a quality improvement (QI) initiative to increase the PPIUCD coverage from current rate of 4.5%-10% in 3-month period. METHOD: A fishbone analysis of the problem was done and the following causes were identified: lack of focused counselling for FP, lack of sensitisation and training of resident doctors and inconsistent supply of intrauterine contraceptive devices (IUCDs). A QI team was constituted with representatives from faculty members, residents, interns, nursing officers and FP counsellors. The point of care quality improvement methodology was used. INTERVENTIONS: Daily counselling of antenatal women was started by the counsellors and interns in antenatal wards. A WhatsApp group of residents was made initially to sensitise them; and later for parking of problems and trouble shooting. The residents were provided hands-on training at skills lab. Uninterrupted supply of IUCDs was ensured by provision of buffer stock of IUCDs with respective store keepers. RESULT: The PPIUCD insertion rates improved from 4.5% to 19.2% at 3 months and have been sustained to a current 30%-35% after 1 ½ years of initiation of the project tiding through the turbulence during the COVID-19 pandemic using QI techniques. CONCLUSION: Sensitisation and training of residents as well as creation of awareness among antenatal women through targeted counselling helped improve PPIUCD coverage at the facility. QI initiatives have the potential to facilitate effective implementation of the FP programmes by strategic utilisation of the resources.


Subject(s)
Contraception , Family Planning Services , Intrauterine Devices , Postpartum Period , Quality Improvement , Adult , COVID-19 , Contraception/statistics & numerical data , Counseling , Female , Health Personnel , Humans , India , Pandemics , Patient Acceptance of Health Care , Patient Discharge , Pregnancy
5.
Eur J Contracept Reprod Health Care ; 26(5): 429-438, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1269458

ABSTRACT

OBJECTIVES: Review evidence is lacking about how contraception is affected by severe social disruption, such as that caused by the COVID-19 pandemic. The purpose of this scoping review was to explore the impact of natural and man-made disasters on contraception in OECD member countries. METHODS: Manual searches and systematic searches in six electronic databases were conducted with no language restrictions. All articles were screened by at least two researchers. The data were analysed thematically. RESULTS: 108 articles were included. Most focussed on the Zika virus outbreak (n = 50) and the COVID-19 pandemic (n = 28). Four key themes were identified: importance of contraception during disasters, impact of disasters on contraceptive behaviour, barriers to contraception during disasters and ways of improving use of contraception during disasters. Despite efforts to increase access to contraception including by transforming ways of delivery, barriers to use meant that unmet need persisted. CONCLUSIONS: To prevent adverse health outcomes and reduce health costs as a result of failure to have access to contraception during disasters, there is a need to intensify efforts to remove barriers to use. This should include increasing access and information on methods of contraception and their side effects (e.g., menstrual suppression) and making contraception freely available.


Subject(s)
COVID-19/prevention & control , Contraception/statistics & numerical data , Disasters , Family Planning Services/organization & administration , Health Services Accessibility/organization & administration , Zika Virus Infection/prevention & control , COVID-19/epidemiology , Humans , Organisation for Economic Co-Operation and Development , Pandemics , SARS-CoV-2 , Zika Virus , Zika Virus Infection/epidemiology
6.
Lancet Glob Health ; 9(6): e793-e801, 2021 06.
Article in English | MEDLINE | ID: covidwho-1233651

ABSTRACT

BACKGROUND: Although hindrances to the sexual and reproductive health of women are expected because of COVID-19, the actual effect of the pandemic on contraceptive use and unintended pregnancy risk in women, particularly in sub-Saharan Africa, remains largely unknown. We aimed to examine population-level changes in the need for and use of contraception by women during the COVID-19 pandemic, determine if these changes differed by sociodemographic characteristics, and compare observed changes during the COVID-19 pandemic with trends in the 2 preceding years. METHODS: In this study, we used four rounds of Performance Monitoring for Action (PMA) population-based survey data collected in four geographies: two at the country level (Burkina Faso and Kenya) and two at the subnational level (Kinshasa, Democratic Republic of the Congo and Lagos, Nigeria). These geographies were selected for this study as they completed surveys immediately before the onset of COVID-19 and implemented a follow-up specific to COVID-19. The first round comprised the baseline PMA panel survey implemented between November, 2019, and February, 2020 (referred to as baseline). The second round comprised telephone-based follow-up surveys between May 28 and July 20, 2020 (referred to as COVID-19 follow-up). The third and fourth rounds comprised two previous cross-sectional survey rounds implemented in the same geographies between 2017 and 2019. FINDINGS: Our analyses were restricted to 7245 women in union (married or living with a partner, as if married) who were interviewed at baseline and COVID-19 follow-up. The proportion of women in need of contraception significantly increased in Lagos only, by 5·81 percentage points (from 74·5% to 80·3%). Contraceptive use among women in need increased significantly in the two rural geographies, with a 17·37 percentage point increase in rural Burkina Faso (30·7% to 48·1%) and a 7·35 percentage point increase in rural Kenya (71·6% to 78·9%). These overall trends mask several distinct patterns by sociodemographic group. Specifically, there was an increase in the need for contraception among nulliparous women across all geographies investigated. INTERPRETATION: Our findings do not support the anticipated deleterious effect of COVID-19 on access to and use of contraceptive services by women in the earliest stages of the pandemic. Although these results are largely encouraging, we warn that these trends might not be sustainable throughout prolonged economic hardship and service disruptions. FUNDING: Bill & Melinda Gates Foundation. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.


Subject(s)
COVID-19/epidemiology , Contraception/statistics & numerical data , Health Services Needs and Demand , Adolescent , Adult , Africa South of the Sahara/epidemiology , Cohort Studies , Female , Health Care Surveys , Humans , Middle Aged , Young Adult
7.
Eur J Contracept Reprod Health Care ; 26(4): 265-271, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1091337

ABSTRACT

PURPOSE: Australia introduced 'lockdown' measures to control COVID-19 on 22 March 2020 which continued for a period of two months. We aimed to investigate the impact this had on sexual and reproductive health (SRH). MATERIALS AND METHODS: Australians aged 18+ were eligible to participate in an online survey from 23 April to 11 May 2020. We report on the experiences of 518 female participants aged <50 years. Pregnancy intentions and contraceptive use were analysed using descriptive statistics. Odds ratios and 95% confidence intervals were calculated to investigate difficulty accessing SRH products and services. Qualitative data were analysed using conventional content analysis. RESULTS: Most participants were aged 18-24 years, and indicated they were trying to avoid pregnancy. The oral contraceptive pill was the most common single method used however nearly 20% reported they were not using contraception. Women who were employed had less trouble accessing contraception during lockdown. Participants reported delaying childbearing or deciding to remain childfree due to COVID-19. CONCLUSION: COVID-19 lockdown impacted the SRH of Australian women. Findings highlight the importance of continued access to SRH services and products during global emergencies.


Subject(s)
COVID-19 , Communicable Disease Control/methods , Contraception Behavior , Contraception , Health Services Accessibility/statistics & numerical data , Reproductive Health Services , Adult , Australia/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Contraception/methods , Contraception/statistics & numerical data , Contraception Behavior/psychology , Contraception Behavior/statistics & numerical data , Decision Making , Female , Health Services Needs and Demand , Humans , Pregnancy , Reproductive Health , Reproductive Health Services/organization & administration , Reproductive Health Services/statistics & numerical data , SARS-CoV-2 , Sexual Health
9.
Am J Trop Med Hyg ; 104(2): 519-525, 2020 Dec 29.
Article in English | MEDLINE | ID: covidwho-1000464

ABSTRACT

The COVID-19 pandemic is a major global concern for public health where high numbers of COVID-19-infected cases and deaths have been recorded. This study assessed the COVID-19 pandemic impact on domestic violence, genital tract health, menstruation, and contraception use among 200 women in Jordan using a self-validated survey questionnaire. The questionnaire was structured to compare frequencies of domestic violence, reproductive tract infections, menstrual irregularities, and contraception use, type, source, and replacement during or after total curfew in Jordan with 6-months before the pandemic; 20.5% of women suffered from increased domestic abuse during the COVID-19 pandemic. Incidence of menstrual problems and genital tract infections was significantly reduced during total curfew compared with 6 months prior (10.5% versus 17.5%; P = 0.016 and 19% versus 25.5%; P = 0.041, respectively). Pre-pandemic state of menstrual problems and genital tract infections was resumed after total curfew. During total curfew, phone consultations were significantly increased (17.5% versus 8.5%; P = 0.01), whereas visiting clinics was significantly reduced (23% versus 5.5%; P = 0.000) to manage menstruation or birth canal infections. Contraception use during total curfew significantly decreased compared with prior (59.5% versus 65.5%; P = 0.017). Using contraception for family planning was reduced significantly during the pandemic than before (P = 0.007). Maternity and childhood centers were more common sources for contraception before than after (14.8% versus 7% or 9.5%; P = 0.001 or P = 0.022). This study is important to evaluate preparedness of Jordanian healthcare systems in facing pandemic situations concerning reproductive health services.


Subject(s)
COVID-19/epidemiology , Contraception/statistics & numerical data , Domestic Violence/statistics & numerical data , Genitalia/physiology , Menstruation , Adolescent , Adult , Ambulatory Care , COVID-19/complications , Cross-Sectional Studies , Family Planning Services , Female , Humans , Jordan/epidemiology , Middle Aged , Young Adult
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