Reproductive health prior to and during COVID-19

Objectives: During the first weeks of the COVID-19 pandemic, many articles projected the potential detrimental effects of the COVID-19 pandemic on reproductive health (RH), emphasizing the importance to continuously address this health area. The two WHO pulse surveys showed substantial disruptions in sexual and reproductive health (SRH) services around the world. The I-SHARE study presents the impact of the COVID-19 pandemic on key RH indicators: fertility intentions, contraceptive use and related barriers, and antenatal care. Methods: See information on the general I-SHARE methodology in the previous abstract. This overview focuses on a sub-sample of the population, i.e. women aged 18-49 years, in 24 countries. Descriptive data is presented per following regions: Sub-Saharan Africa (SSA), Latin America and the Caribbean (LAC), North America (NA), Europe and Central Asia (ECA), East Asia and the Pacific (EAP). Results: The total sample of women in analysis was 13,405, with most coming from ECA (7,223) and LAC (3,962). The mean age of respondents was 30 years and over 96% reported to be cis-gender. The majority lived in (semi-)urban areas (81%) and had some/completed higher education (77%). Accessing contraceptives during COVID-19 was most difficult for women in East Asia and the Pacific (EAP) (11.4%) and LAC (10.6%). The ECA region reported the lowest proportion of women having problems accessing contraceptives (5.6%). Eighty-five per cent of women reported not changing their fertility intentions due to the pandemic. A total of 10.4% (n=1101) said they postponed their fertility desire (26% of respondents from SSA), while 4.3% (n=450) reported having decided to have a child sooner. Data from LAC and ECA regarding pregnancy indicated that 50.8% of the pregnant respondents from LAC and over 80.9% from ECA reported being happy with their pregnancy. A substantial proportion had not planned to get pregnant (50% in LAC and 30% in ECA). Over 40% of respondents from LAC reported that their pregnancy had something to do with COVID-19 (e.g., reduced access to contraceptives or increased idling around in the communities), while this was 15.8% in ECA. Pregnant women reported substantial anxiety and depression because of COVID-19 (71.7% in LAC and 60.5% in ECA). A substantial proportion of pregnant women reported missing pregnancy care appointments during COVID-19 (83.8%) and not being satisfied with pregnancy health care during COVID-19 (34.7%). Conclusion: The study demonstrates an overall impact of COVID-19 on fertility intentions, contraceptive access and use, and routine maternal health care services.