Figures & Tables
Figures
- FIGURE
Study Design Summary Examining Behaviors Related to Contraceptive Access and Use During the COVID-19 Pandemic in 4 Countries
Abbreviation: COVID-19, coronavirus disease.
Tables
Outcome Measures Data Source Unintended pregnancy Proportion of pregnant women reporting that their pregnancy was planned at a later time (mistimed) or not planned at all (unplanned) 3-2-1 survey Contribution of COVID-19 pandemic to unintended pregnancy Proportion of women with an unintended pregnancy who responded “yes” when asked if the COVID-19 pandemic and the coronavirus social restrictions had affected their ability to avoid or delay getting pregnant 3-2-1 survey Pre-pandemic modern contraceptive use Proportion of women who reported they were using an implant, IUD, injectables, pills, emergency contraception, condoms, Standard Days Method, or Lactational Amenorrhea Method when the COVID-19 restrictions began in March 2020 (Malawi, Niger, Uganda) or April/May 2020 (Nepal) Outbound survey Current modern contraceptive use Proportion of women who reported they were using an implant, IUD, injectables, pills, emergency contraception, condoms, Standard Days Method, or Lactational Amenorrhea Method at the time of the survey 3-2-1 survey Method choice Proportion of current modern method users who said “yes” when asked if their current method was the method that they wanted to use. The question was only asked of current method users who were using a short-term method (injectables, pills, emergency contraception, condoms, Standard Days Method, or Lactational Amenorrhea Method) and current LARC users who said their method had been inserted after the COVID-19 restrictions began in March 2020 (Malawi, Niger, Uganda) or April/May 2020 (Nepal) Outbound survey Barriers to use Proportion of nonusers of modern contraception who said “yes” when asked if they had wanted to obtain a method since the COVID-19 restrictions began in March 2020 (Malawi, Niger, Uganda) or April/May 2020 (Nepal) and who said “yes” when asked if they had tried to obtain a method Outbound survey Abbreviations: COVID-19, coronavirus disease; IUD, intrauterine contraceptive device; LARC, long-acting reversible contraception.
- TABLE 2.
Characteristics, Contraceptive Use, and Pregnancies Among 3-2-1 Survey Participants
Malawi, %(N=4,936) Nepal, %(N=6,776) Niger, %(N=2,602) Uganda, %(N=7,378) Age, years 18–24 77.9 70.0 79.9 76.7 25–34 21.9 22.8 13.3 19.1 35–49 0.2 7.2 6.8 4.2 Current pregnancy and contraceptive use statusa Pregnant 25.2 25.5 38.3 24.6 Nonpermanent modern method 37.5 29.4 18.1 28.9 Traditional method 0.1 1.0 2.8 2.0 Permanent or any other method 0.2 2.6 7.3 2.7 Nonuser not wanting to get pregnant within 2 years 27.4 29.4 21.9 30.3 Nonuser wanting to get pregnant within 2 years 9.5 12.0 11.7 11.7 Pregnancies by pregnancy intentionb n=1,245 n=1,731 n=996 n=1,812 Planned 49.2 69.1 58.7 45.3 Mistimed, not COVID-19-related 5.5 2.4 5.2 4.9 Unplanned, not COVID-19-related 5.9 1.6 5.4 5.9 Mistimed, COVID-19-related 23.8 20.9 17.7 28.4 Unplanned, COVID-19-related 15.7 6.0 13.0 15.5 n=633 n=535 n=411 n=992 COVID-19-related unintended pregnanciesc 77.6 87.1 74.2 80.2 Main reason for COVID-19-related unintended pregnanciesd n=491 n=466 n=305 n=796 Family planning services closed 22.4 12.9 25.8 19.8 Preferred method unavailable 77.6 87.1 74.2 80.2 Afraid of getting COVID-19 9.0 19.2 5.0 22.8 Family would not allow going to get a method due to COVID-19 18.1 27.6 14.8 20.7 Government restrictions 1.4 0.6 1.6 2.4 Other family planning access reason 4.1 1.1 4.3 2.0 Other reason not related to accessing contraception 34.0 33.5 40.7 44.3 Abbreviations: COVID-19, coronavirus disease; IUD, intrauterine contraceptive device; LAM, lactational amenorrhea method; SDM, standard days method.
↵a Nonpermanent modern methods include implants, IUD, injectables, pills, emergency contraception, condoms, SDM, and LAM. Traditional methods include withdrawal, rhythm method, or folk methods like herbs.
↵b Among pregnant women.
↵c Among pregnant women with an unplanned or mistimed pregnancy.
↵d Among pregnant women with an unplanned or mistimed pregnancy who reported that COVID-19 affected their ability to avoid or delay pregnancy.
Malawi, %(N=1,694) Nepal, %(N=1,468) Niger, %(N=458) Uganda, %(N=1,504) Age, years 18–24 72.7 62.3 79.9 74.5 25–49 27.3 37.7 20.1 25.5 Married, % 73.8 87.3 76.4 68.2 Parity, % 0 11.7 16.3 25.1 19.4 1 38.1 39.4 27.7 35.0 2 22.7 29.5 20.1 23.3 3+ 27.4 14.8 27.1 22.3 Highest education None 8.5 12.2 41.9 8.5 Some primary 44.0 33.0 32.8 34.7 Finished primary 22.1 13.3 8.5 27.5 Finished secondary 22.8 22.0 10.7 21.3 More than secondary 2.5 19.6 6.1 8.0 Concern about getting infected with COVID-19 A little/not concerned or has/had COVID-19 49.1 58.8 28.6 22.5 Concerned 19.3 18.3 28.8 23.9 Very concerned 31.6 23.0 42.6 53.5 Household income loss during COVID-19 None 16.3 19.4 26.9 13.9 Small part 56.6 33.8 53.3 42.6 Moderate part 9.0 19.2 5.0 22.8 Large part/all 18.1 27.6 14.8 20.7 Abbreviation: COVID-19, coronavirus disease.
Malawi, %(N=1,694) Nepal, %(N=1,468) Niger, %(N=458) Uganda, %(N=1,504) Pre-pandemic contraceptive use Pre-pandemic contraceptive use, including traditional methods 78.4 57.4 46.5 66.4 Pre-pandemic modern contraceptive use 75.0 54.7 40.4 59.8 Pre-pandemic modern method mixb n=1,271 n=803 n=185 n=900 Implant 54.8 32.8 48.1 36.9 IUD 8.3 8.6 18.9 15.0 Injectable 22.3 23.0 13.5 21.7 Pill 4.3 2.1 13.5 4.1 Emergency contraception 2.1 10.3 2.7 4.0 Condoms 7.8 22.8 0.0 14.7 SDM/cycle beads or LAM 0.4 0.4 3.2 3.7 Pre-pandemic source of supplyc n=1,268 n=800 n=182 n=887 Public sector facility 83.5 76.6 65.9 65.5 Private sector facility 8.6 15.8 15.4 20.3 Community health worker or outreach event 6.7 3.3 11.0 8.0 Pharmacy, chemical, or drug shop 1.2 4.1 4.9 5.2 Ordered on a website, app, or phone 0.0 0.3 2.7 1.0 Current contraceptive use Current contraceptive use, including traditional methods 58.1 50.7 49.6 53.9 Current modern contraceptive use 58.0 48.2 42.1 48.8 Current modern method mixd n=982 n=708 n=193 n=734 Implant 44.5 28.4 33.7 32.8 IUD 5.9 8.5 10.9 10.6 Injectable 30.2 25.1 21.2 23.7 Pill 3.4 11.2 23.3 6.7 Emergency contraception 4.3 3.1 5.7 3.4 Condoms 8.8 23.2 1.0 17.3 SDM/cycle beads or LAM 3.0 0.6 4.1 5.4 Current source of supplye n=622 n=573 n=159 n=592 Public sector facility 77.8 74.5 62.3 66.2 Private sector facility 10.5 14.8 15.1 21.8 Community health worker or outreach event 9.8 3.5 12.6 6.1 Pharmacy, chemical, or drug shop 1.4 6.8 2.5 4.6 Ordered on a website, app, or phone 0.5 0.3 7.5 1.4 Main reason for choosing current source of supplye n=622 n=573 n=159 n=592 Family planning services closed elsewhere 87.5 26.9 29.6 21.6 Preferred method unavailable elsewhere 11.7 23.9 28.9 18.8 Afraid of getting COVID-19 elsewhere 0.3 25.1 18.9 45.8 Family would not allow going elsewhere due to COVID-19 0.3 3.7 6.9 4.7 Government restrictions 0.2 5.8 9.4 7.4 Other 0.0 14.7 6.3 1.7 Changes in contraceptive use Change in modern contraceptive status n=1,694 n=1,468 n=458 n=1,504 Consistent user 50.0 40.1 23.4 39.6 Discontinuer 25.0 14.6 17.0 20.2 Adopter 8.0 8.1 18.8 9.2 Consistent nonuser 17.0 37.2 40.8 31.0 Change in contraceptive methodsf n=847 n=589 n=107 n=596 Less effective method 18.2 11.2 30.8 16.6 Method as effective 77.1 74.5 61.7 77.3 More effective method 4.7 14.3 7.5 6.0 Abbreviations: COVID-19, coronavirus disease; EC, emergency contraception; IUD, intrauterine device; LAM, lactational amenorrhea method; SDM, standard days method.
↵a Outbound survey participants include (1) nonpregnant women using nonpermanent, modern contraception and (2) nonpregnant women who do not want to get pregnant within the next two years and are not using modern contraception. Due to study design, in this table, modern methods refer to nonpermanent, modern contraceptive methods including implants, IUDs, injectables, pills, emergency contraception, condoms, SDM, and LAM.
↵b Among pre-pandemic modern method users.
↵c Among pre-pandemic users of modern contraception other than LAM.
↵d Among current users of modern, nonpermanent contraception (implants, IUDs, injectables,, pills, EC, condoms, SDM, or LAM).
↵e Among current users of modern contraception other than LAM who obtained/resupplied during COVID-19.
↵f Among consistent users of modern contraception.
- TABLE 5
Adjusted Odds Ratio Estimates and 95% Confidence Intervals for Factors Associated With Adoption and Discontinuation of Modern Contraception During the COVID-19 Pandemic, by Country
Malawi Nepal Niger Uganda Factor Adoption AmongNonusers,a AOR(95% CI)(n=423) DiscontinuationAmong Users, AOR(95% CI)(n=1,268) Adoption AmongNonusers,aAOR(95% CI)(n=665) DiscontinuationAmong Users, AOR(95% CI)(n=800) Adoption AmongNonusers,aAOR(95% CI)(n=273) DiscontinuationAmong Users, AOR(95% CI)(n=182) Adoption AmongNonusers,aAOR(95% CI)(n=604) DiscontinuationAmong Users, AOR(95% CI)(n=887) Age (25–49 vs. 18–24b) 0.80 (0.47, 1.35) 0.74 (0.55, 1.00) 0.51 (0.31, 0.84)c 0.76 (0.53, 1.10) 1.12 (0.57, 2.18) 0.66 (0.29, 1.47) 0.91 (0.56, 1.49) 1.10 (0.79, 1.53) Married 2.23 (1.40, 3.54)c 0.70 (0.52, 0.93) 3.06 (1.53, 6.10)c 0.73 (0.41, 1.29) 1.74 (0.93, 3.25) 0.94 (0.40, 2.21) 1.02 (0.67, 1.54) 0.87 (0.63, 1.18) Parity (2+ vs. 0–1b) 1.13 (0.69, 1.84) 0.97 (0.74, 1.27) 1.36 (0.87, 2.13) 0.86 (0.61, 1.23) 1.31 (0.75, 2.27) 0.82 (0.42, 1.60) 2.00 (1.31, 3.06)c 1.10 (0.81, 1.49) Education (higher vs. lowerb,d) 0.98 (0.62, 1.53) 1.34 (1.04, 1.71)c 0.71 (0.46, 1.10) 0.92 (0.66, 1.28) 1.22 (0.71, 2.10) 0.44 (0.24, 0.84)c 0.79 (0.53, 1.18) 0.89 (0.66, 1.19) Concern about COVID-19 infection (little/not concerned or has/had COVID-19b) Concerned 1.18 (0.67, 2.07) 0.86 (0.62, 1.20) 0.76 (0.41, 1.42) 1.00 (0.66, 1.51) 0.55 (0.27, 1.10) 1.10 (0.49, 2.51) 0.46 (0.26, 0.81)c 0.74 (0.49, 1.14) Very concerned 0.85 (0.52, 1.40) 1.34 (1.02, 1.75)c 1.47 (0.91, 2.37) 0.92 (0.61, 1.37) 0.93 (0.51, 1.69) 0.60 (0.27, 1.33) 0.60 (0.38, 0.96)c 0.93 (0.65, 1.33) Household income loss due to COVID-19 (noneb) Small n/a n/a 1.80 (0.98, 3.30) 0.97 (0.62, 1.52) n/a n/a 1.39 (0.75, 2.58) 0.83 (0.53, 1.30) Moderate/large/all n/a n/a 1.51 (0.82, 2.76) 0.90 (0.58, 1.40) n/a n/a 1.32 (0.72, 2.44) 1.09 (0.70, 1.70) Any 0.96 (0.53, 1.74) 1.37 (0.97, 1.91) n/a n/a 1.09 (0.57, 2.09) 0.86 (0.42, 1.74) n/a n/a Pre-pandemic method (long-acting vs. short-actingb) n/a 0.85 (0.66, 1.09) n/a 0.89 (0.64, 1.25) n/a 0.66 (0.34, 1.27) n/a 0.84 (0.63, 1.13) Pre-pandemic source of supply (public facilityb) Private facility n/a 1.02 (0.67, 1.56) n/a 1.49 (0.98, 2.27) n/a 1.31 (0.54, 3.21) n/a 1.35 (0.94, 1.94) CHW/outreach/pharmacy/online n/a 0.89 (0.57, 1.40) n/a 0.89 (0.47, 1.68) n/a 1.18 (0.52, 2.66) n/a 2.08 (1.38, 3.12)c Abbreviations: AOR, adjusted odds ratio; CHW, community health worker; CI, confidence interval; COVID-19, coronavirus disease.
↵a Nonusers are nonpregnant women who reported using a traditional method or not using any form of contraception, and also reported that they did not want to get pregnant in the next 2 years. Users include current users of nonpermanent, modern contraception.
↵b Reference.
↵c Statistically significant (P ≤ .05).
d In Malawi, Nepal and Uganda, lower includes none and some primary, and higher includes finished primary, finished secondary, and higher. In Niger, lower includes none, and higher includes all other categories.
- TABLE 6.
Method Choicea Among Current Nonpermanent Method Users and LARC Removals Among LARC Users, by Country
Malawi Nepal Niger Uganda n=635 n=575 n=165 n=606 Obtained preferred method, % (95% CI) 83.9 (80.8, 86.7) 87.8 (84.9, 90.4) 79.4 (72.4, 85.3) 84.2 (81.0, 87.0) Main reason for not obtaining preferred method, %b n=78 n=44 n=26 n=65 Preferred method unavailable 34.6 52.3 30.8 30.8 Provider unable to provide preferred method 20.5 15.9 46.2 24.6 Provider recommended another method/not eligible 17.9 20.5 15.4 4.6 Not enough money 11.5 6.8 7.7 15.4 Afraid of getting COVID-19 6.4 4.5 0.0 21.5 Other 9.0 0.0 0.0 3.1 LARC removalsc n=495 n=261 n=86 n=319 Tried to get LARC removed, % 45.7 36.8 54.7 17.6 Main reason for not being able to have LARC removed, %d n=226 n=96 n=47 n=56 No provider available/place closed 35.8 67.7 46.8 21.4 No equipment/supplies for removal 23.0 10.4 21.3 25.0 Provider advised to keep method 20.8 9.4 10.6 23.2 Not enough money 11.1 7.3 12.8 21.4 Other 9.3 5.2 8.5 8.9 Abbreviations: CI, confidence interval; COVID-19, coronavirus disease; IUD, intrauterine device; LAM, lactational amenorrhea method; LARC, long-acting reversible contraception.
↵a At last episode of use: calculated for current modern method users who last obtained/resupplied their method during COVID-19 or who use LAM.
↵b Among current modern method users who last obtained their method during COVID-19 and are not using their preferred method.
↵c Among current implant and IUD users.
↵d Among current implant and IUD users who tried to have their method removed.
Malawi, % Nepal, % Niger, % Uganda, % n=712 n=760 n=265 n=770 Intention to get modern method Did not want method 34.1 62.1 50.9 34.4 Wanted method, did not try obtaining one 13.6 9.3 12.1 12.5 Tried obtaining a method 52.2 28.6 37.0 53.1 Reasons for not trying to obtain a methodb n=97 n=71 n=32 n=96 Family planning services closed 20.6 21.1 18.8 16.7 Afraid of getting COVID-19 48.5 52.1 50.0 49.0 Family would not allow going to get a method due to COVID-19 2.1 7.0 12.5 12.5 Government restrictions 15.5 7.0 9.4 9.4 Other 13.4 12.7 9.4 12.5 Reasons for not obtaining a method among those who triedc n=372 n=217 n=98 n=409 Preferred method unavailable 31.2 60.4 32.7 29.3 Provider unable to provide preferred method 25.8 12.9 22.4 13.0 Provider recommended another method 11.8 8.8 10.2 15.6 Not enough money 12.4 7.4 31.6 30.8 Other 18.8 10.6 3.1 11.2 Abbreviation: COVID-19, coronavirus disease.
↵a Nonusers include nonpregnant women who reported using a traditional method or not using any form of contraception but did not want to get pregnant in the next two years.
↵b Among current nonusers of modern contraception who wanted a method but did not try obtaining one.
↵c Among current nonusers of modern contraception who tried obtaining a method.
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