Impact of the COVID-19 Pandemic on Contraceptive Services at Selected Primary Health Care Facilities in India, Nigeria, and Tanzania: Cross-Sectional Study

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Background: The COVID-19 pandemic disrupted sexual and reproductive health services, including family planning (FP) and contraceptive services. The World Health Organization conducted a multicountry study in India, Nigeria, and Tanzania to determine the impact of the pandemic on the health system's readiness to provide contraception services and trends in contraceptive uptake. Objective: This study aimed to determine the status, availability, and health facility readiness to provide contraceptive services and to compare trends in contraceptive uptake before and during the pandemic. Methods: This cross-sectional study was conducted by the Indian Council of Medical Research-National Institute of Research in Reproductive and Child Health (India), the University of Ilorin Teaching Hospital (Nigeria), and the Ifakara Health Institute (Tanzania). A total of 50 primary health facilities (11 in India, 6 in Nigeria, and 33 in Tanzania) were evaluated using a standardized facility assessment questionnaire, completed by the most knowledgeable senior health care provider or administrator at the facility. Monthly data on service utilization and contraceptive availability were collected to capture trends before and during the COVID-19 pandemic. Data were collected from May to August 2022. The study received ethical and scientific approval from the World Health Organization Ethics Review Committee and Research Project Review Panel and national regulatory bodies. Key outcomes included availability of FP guidelines and tools, service disruptions including contraceptive and abortion services, stock-outs, reasons for service disruptions, and mitigation measures to sustain service deliveries. Descriptive analysis was used to summarize the key trends and patterns. Results: Health facilities in all three countries reported shortages of various contraceptives. Contraceptive services were partially disrupted in 91% facilities in India, 83% facilities in Nigeria, and 43% facilities in Tanzania. Abortion services were partially disrupted in all surveyed facilities offering these services in India and Nigeria and in 26.7% of facilities in Tanzania. Client visits declined in health facilities in 2020 compared to 2019 in India (30%) and Nigeria (11%), with a gradual recovery thereafter. In contrast, Tanzania experienced a 1% decline in client visits in 2020. Readiness measures such as telemedicine, task shifting, community outreach, triaging, and patient redirection were implemented to minimize service disruptions. Conclusions: This study provides crucial insights into the challenges posed by the COVID-19 pandemic on contraceptive services and the measures taken to alleviate them. The findings can help countries to better prepare to prevent the disruption of FP and contraceptive services in future pandemics or emergencies.

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