A study on obstacles and challenges in gaining access to contraception in COVID era

2. OBSTACLES & CHALLENGES IN
GAINING ACCESS TO FAMILY
PLANNING SERVICES IN COVID ERA
Dr. Vidhyalakshmi R K
Assistant Professor
Department of O & G
SRMMCH & RC
Chennai

3. Contraception
● Lifesaving
● Integral component of reproductive health
Accessibility as well as affordability improve
● Women’s reproductive autonomy
● Reduce unintended pregnancies
● Profoundly impact women as well as family health and well-being
particularly in times of stress and hardships
The Novel Coronavirus disease first started as an epidemic in China became the fastest growing public
health pandemic of the century in due short course of time

4. Covid 19 Impact
● Complete or partial lock down
● Unequal burden in health care system
● Hindered the accessibility to the
○ Contraception
○ Safe abortion
○ Family planning services
Resulting in 2.7 million unintended pregnancies in the first year
● Upsurge in unwanted pregnancies
● Unsafe abortions and associated complications

5. Our stand during Pandemic
WHO - continuation of SRH amid COVID-19 pandemic, but hindered…..
○ Shift in the point of health care services towards COVID-19 patient management
○ Non-compliance of patients due to COVID-19 fear
○ Lack of clinical resources allocation
○ Transportation as well as economical issues

6. Rationale behind this Study
● Continuing SRH services during pandemic has been evidently challenging
● Dearth of studies which specifically investigated the COVID-19 impact on reproductive health care services
● Hence our study aims to determine the challenges in the accessibility to family planning services as well as
the impact on contraception and safe abortion services during COVID-19 era

7. Methods
● Cross-sectional descriptive study
● Reproductive age group women (18-45 yrs)
● OP clinic of OG in tertiary health care centre
● 197 women were enrolled in the study for duration of 3.5 months
● Random patients selection
● After fulfilling inclusion and exclusion criteria

8. Criteria
Inclusion Criteria
● Willing to participate
● Sexually active
● Reproductive age
● consent
Exclusion Criteria
● Psychiatric disorders
● Mentally challenged
● Permanent sterilization
● Not willing to participate

9. Questionarrie
● Pretested
● Validated
● Semi-structured questionnaire
questions regarding
● Sociodemographic characteristics
● Awareness on contraception use
● Difficulties in gaining family planning and contraception access
● Reasons for avoiding contraception during COVID-19 pandemic &
● Outcome
filled by the interviewer after interviewing the patients

10. Statistical Analysis
● SPSS version 20 software
● For Continuos data - Mean as well as standard deviation
● For Categorical data - Percentage
● Chi square test - Analyze the association of complications during pregnancy termination with age group,
parity, method of termination and difficulty in accessing medical facility during covid time for pregnancy
termination
● The p value less than 0.05 was considered statistically significant

11. RESULTS

12. Table 1. Contraceptive and family planning services implementation challenges
Parameter Sub-group No. (%) of respondents
Parity Primi 49 (24.87)
Multi 148 (75.13)
Contraception knowledge Yes 191 (96.95)
No 6 (3.05)
Current contraception Yes 148 (75.13)
No 49 (24.87)
Methods used Natural 34 (17.26)
Barrier 71 (36.04)
Hormonal Injection 8 (4.06)
Hormonal pills 30 (15.23)
IUCD*
5 (2.54)
Not applicable 49 (24.87)

13. Challenges Sub-group No. (%) of respondents
Difficulty in gaining access to contraception
Yes 97 (49.24)
No 42 (21.32)
Not applicable 58 (29.44)
Type of difficulty
Consulting specialist 25 (12.69)
COVID fear 15 (7.61)
Non availability 33 (16.75)
Transport 29 (14.72)
Not applicable 95 (48.22)
Unplanned pregnancy
Yes 97 (49.24)
No 100 (50.76)
Pregnancy continuation and termination (n=97)
Continued 70 (35.53)
Terminated 27 (13.71)
No pregnancy 100 (50.76)
Reason for continuing pregnancy (n=70)
Diagnostic delay 16 (22.86)
Family pressure 5 (7.14)
Non-availability of FP* services 49 (70.00)
Pregnancy termination method (n=27)
Specialist - Gynaecologist 9 (33.33)
General medical practitioner 18 (66.67)
Reason for GP (n=18)
Consulting specialist 17 (94.44)
COVID fear 1 (5.56)
Complication in pregnancy termination (n=27)
Yes 15 (55.56)
No 12 (44.44)
Difficulty in accessing medical facility for pregnancy
termination (n=27)
Yes 15 (55.56)
No 12 (44.44)

14. Table 2: Comparison between pregnancy termination method approached and associated medical
complications with Chi-Square test
How pregnancy terminated
Complications in pregnancy
termination
Total
No Yes
Specialist 8 1 9
General medical
practitioner
4 14 18
Total 12 15 27
Value df Asymp. Sig.
(2-sided)
Exact
Sig. (2-
sided)
Exact
Sig. (1-
sided)
Pearson Chi-Square 10.800a 1 .001
Continuity Correctionb 8.269 1 .004
Likelihood Ratio 11.748 1 .001
Fisher's Exact Test .003 .002
N of Valid Cases 27

15. Table 3: Comparison between difficulty in accessing medical facility and medical complications in pregnancy
termination
Difficulty in accessing
medical specialist
facility for pregnancy
termination
Complications in pregnancy
termination
Total
No Yes
No 10 2 12
Yes 2 13 15
Total
12 15 27
Value df Asymp.
Sig. (2-
sided)
Exact Sig.
(2-sided)
Exact Sig.
(1-sided)
Pearson Chi-
Square
13.23
0a
1 .000
Continuity
Correctionb
10.54
7
1 .001
Likelihood Ratio
14.50
2
1 .000
Fisher's Exact
Test
.000 .000

16. DISCUSSION

17. The mean age of the respondents was 26.27 years with predominant age group of 21-30 years (81.7%)
Among the respondents,
● 25 % primi & 75% multi
● Majority (96.95% ) have contraception knowledge (but, Nigeria 82% and Pakistan 68.5%), however in the rural area of Nagpur
(India) had comparable knowledge regarding contraception (100%)
● 75% were using various contraception methods
Among the contraceptive users,
● Barrier method was the majorly used contraception measure (36.04%)

18. During COVID-19 era, almost half of the study population (49.24%) faced difficulty in following any form of
contraceptive measure
Guttmacher Institute in its recent analysis reported
● 10% decline in the Sexual and Reproductive Health (SRH) services in low and middle income countries
(LMICs) owing to COVID-19 would led to an additional 15.4 million unintended pregnancies, unsafe
abortions over 3.3 million and 28000 maternal mortalities

19. COVID-19 has impacted women’s ability to use contraceptive measure & FP services in numerous ways
● Limited production, distribution as well as availability
● Redirection of services to COVID-19 management
● Lockdown and fear of getting exposed to COVID-19
● Supported by findings of our study where,
○ Only 33% of the women underwent termination under specialist care
○ 67% women approached general medical practitioner for pregnancy termination
○ The prime reason was difficulty in consulting specialist during the lockdown period (94.44%)

20. Conclusion
COVID-19 pandemic has made the goal of achieving universal access to SRH services by 2030 more
challenging
● Continuing medical health services including contraception and safe abortion services are essential during
pandemic to sustain the success of high-quality reproductive services which will significantly decrease
maternal morbidity as well as mortality thereby improving newborn and child health