Impact of COVID-19 on Family Planning in Africa and Asia
See the data
Additional Information +
Explore the impacts of COVID-19 on contraceptive use
Background
COVID-19 was expected to have devastating impacts on family planning. Did it?
Explore interactive charts for seven countries in Africa and Asia to find answers to how COVID-19 impacted contraceptive use and learn about three country experiences successfully adapting their programs.
About the Data
The Data
Program Adaptations
Key Implications
Downloadable Data and Other Links
About the Data
Data Sources
Pregnancy Desires
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Contraceptive Use
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Switching to Less Effective or No Method
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COVID-19 Impact on Contraceptive Non-Use
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FP Indicator Descriptions
Percent of women who changed their mind about wanting to become pregnant because of COVID-19 concerns. Because the survey question is framed as a yes/no question, it is not known whether women changed their mind to preferring to delay pregnancy or to become pregnant sooner.
Pregnancy desires
Collaborators:
Synthesized by Knowledge SUCCESS in collaboration with Performance Monitoring for Action (PMA), the Family Planning Association of Nepal (FPAN), Access Collaborative, Breakthrough ACTION, and West Africa Breakthrough ACTION (WABA).
Although the pandemic has resulted in many disruptions to health services, including family planning (FP) services, it has also led to some positive adaptations to FP policies, programs, and services around the world that could be applied in other contexts—and that could have lasting implications beyond the pandemic era. In April 2020, UNFPA estimated that if COVID-19-related disruptions in health services continued for 6 months, 7 million unintended pregnancies could occur. One year into the pandemic, estimates put the figure closer to 1.4 million. While this number is still troubling, it indicates that the impacts of COVID-19 on unintended pregnancy during the first year of the pandemic may not have been as dire as originally feared.
The FP-related data in the map of COVID-19 impacts are from nationally or sub-nationally representative PMA panel surveys conducted by PMA between June 2020 and February 2021 from:
Burkina Faso (3 surveys)
Côte d’Ivoire (1 survey)
Kenya (3 surveys)
Kinshasa, Democratic Republic of the Congo (DRC) (3 surveys)
Lagos, Nigeria (3 surveys)
Rajasthan, India (1 survey)
Uganda (1 survey)
COVID-19-related data were compiled from Our World in Data, from Coronavirus Pandemic (COVID-19) for COVID-19 cases and deaths and COVID-19: Stay-at-Home Restrictions for government policies on stay-at-home requirements or household lockdowns.
Important notes +
About Connecting the Dots:
Connecting the Dots combines different pieces of information – in this case, the latest evidence with implementation experiences – to help technical advisors and program managers understand emerging trends in family planning and inform adaptations to their own programs.
About Connecting the Dots:
Connecting the Dots combines different pieces of information – in this case, the latest evidence with implementation experiences – to help technical advisors and program managers understand emerging trends in family planning and inform adaptations to their own programs.
Acknowledgments:
Writers:
Catherine Packer, FHI 360; Alison Bodenheimer, FHI 360
Data preparation:
Celia Karp, PMA; Shannon Wood, PMA
Technical input and review:
Ruwaida Salem, Johns Hopkins Center for Communication Programs (CCP); Reana Thomas, FHI 360; Pranab Rajbhandari, CCP; Tara Sullivan, CCP; Anne Kott, CCP; Sophie Weiner, CCP
Suggested citation:
Packer C., Bodenheimer A. Connecting the Dots Between Evidence and Experience. Impact of COVID-19 on Family Planning in Africa and Asia. Baltimore: Knowledge SUCCESS, Johns Hopkins Center for Communication Programs; January 2022.
All FP-related data are population-level estimates of each indicator per time point (i.e., women are not linked over time to estimate individual-level changes).
It is important to note that while the charts show FP-related data for women overall, COVID-19 may have impacted subgroups of women differently (e.g., age, parity, urban/rural residence).
Number of COVID-19 cases and deaths may be underreported in some settings.
In countries where testing is low, the actual number of cases may be much higher than is reported in the case graphs.
Though stay-at-home restrictions may have been officially in place, subnational regions may have had differing levels of restrictions that may not have been followed.
Percent of women at risk of unintended pregnancy (non-pregnant, non-infertile, married/partnered women who do not want to have a child within the next year) using any modern or traditional contraception.
Contraceptive use
Percent of women at risk of unintended pregnancy who changed to a less effective or no method. Contraceptive users were placed into three groups based on the effectiveness of the method they were using:
Switching to Less Effective or No Method
More effective methods (implant, IUD, sterilization)
Effective methods (injectable, pill, diaphragm)
Less effective methods (condoms, lactational amenorrhea, standard days method, emergency contraception, traditional, other)
Percent of women at risk of unintended pregnancy not using contraception for COVID-19-related reasons.
Women were able to choose multiple reasons related to COVID-19 or other barriers.
Preferred contraceptive method was not available
The facility was closed or services were not available
Government restrictions
Fear of being infected with COVID-19 at a facility
Other COVID-19-related reasons
COVID-19 Impact on Contraceptive Non-Use
kinshasa, drc
Keep Reading
included:
Program Adaptations
Program adaptations can help ensure continuity of FP services during COVID-19 and other emergency situations.
Here we take a closer look at three specific country examples of FP program adaptations from Nepal, Côte d’Ivoire, and Madagascar, synthesized from existing documentation and correspondence with project staff.
Click on a country to download the full case study
Nepal
Côte d’Ivoire
Key Implications
However, there were some subgroups that may have been harder hit.
The evidence and experience shared here answer a number of key questions that will help FP technical advisors and program implementers plan for later in the pandemic and future pandemics or crises.
Click to read the answer
To be continued …
The pandemic is not over. The data shared here are from the first year of the COVID-19 pandemic from a limited number of countries, mostly in sub-Saharan Africa. COVID-19 may have had, and continue to have, more severe effects on FP services and use in other regions of the world or other countries not included in this analysis.
Downloadable data and other links
Dive into subgroup differences
Explore the FP insight Collection, "Connecting the Dots: COVID-19 and Family Planning"
Get a behind-the-scenes look at the development of Connecting the Dots
Download the case study
There were some indications in the data that the COVID-19 situation was worsening in some contexts, such as larger proportions of women not using contraception for COVID-19-related reasons in some countries 6-10 months into the pandemic.
PMA’s later COVID-19 surveys took place 8-10 months into the pandemic, as many countries were beginning to experience a second wave of COVID-19 cases. Therefore, the next surveys may show more of a negative impact of the COVID-19 pandemic on FP use. The situation is rapidly changing in different countries and, by the time of publication, a very different story may be the reality.
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Through emergency funding, the Family Planning Association of Nepal (FPAN) quickly reestablished FP services early in the pandemic through walk-in services, outreach by CHWs, and telehealth consultations, resulting in comparable numbers of clients served as before the pandemic.
Download the case study
Breakthrough ACTION and West Africa Breakthrough ACTION (WABA) adapted its FP public service announcements for a social and behavior change radio campaign to include messages about how to access safe services during the pandemic. Exposure to the campaign was associated with positive FP care-seeking attitudes and intentions.
Madagascar
Download the case study
The Madagascar Ministry of Health and DMPA-SC Access Collaborative successfully introduced and scaled up DMPA-SC self-injection through remote supervision of FP providers.
In seven countries with PMA data, few women changed their minds about wanting to become pregnant due to COVID-19 concerns early in the pandemic, and in the four settings with multiple PMA surveys this seemed to decrease over time.
In the four settings with multiple PMA surveys, there was very little change in contraceptive use in the first 10 months of the COVID-19 pandemic, and few women switched to less effective methods or stopped using contraception. However, there were slight increases at the later COVID-19 survey in all four settings, potentially indicating a worsening situation.
Very few non-users cited COVID-19-related reasons for contraceptive non-use at the earlier COVID-19 survey in three settings, but this increased by the later COVID-19 survey. And in three countries with a single COVID-19 survey 8-10 months into the pandemic, a substantial percentage of non-users cited COVID-19-related reasons for contraceptive non-use. These data suggest that COVID-19 may have had larger impacts on contraceptive non-use later in the pandemic than earlier.
kinshasa, drc
During the earlier COVID-19 survey, there were more restrictive stay-at-home orders (can leave the house for daily exercise, grocery shopping, and ‘essential’ trips) and cases were steeply rising for the first time. During the later COVID-19 survey, after a flattening of the curve and removal of stay-at-home restrictions, COVID-19 cases began to rise steeply again and the more restrictive stay-at-home orders were put back in place. COVID-19 seemed to have very little impact on women’s pregnancy desires and contraceptive use in Kinshasa.
Click to see other indicators
Pregnancy Desires
Contraceptive Use
Switching to Less Effective or No Method
COVID-19 Impact on Contraceptive Non-Use
Percentage of Women
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Pregnancy Desires
At the earlier COVID-19 survey, 11% of women said they changed their minds about becoming pregnant due to COVID-19 concerns and this decreased to 3% at the later COVID-19 survey.
Pregnancy Desires
Contraceptive Use
There was very little change in contraceptive use over time as it was around 70% at all three timepoints.
Contraceptive Use
Switching to Less Effective or No Method
Between the pre-pandemic and earlier COVID-19 survey, 7% of women switched to a less effective or no method, and this increased to 18% at the later COVID-19 survey.
Switching to Less Effective or No Method
COVID-19 Impact on Contraceptive Non-Use
At the earlier COVID-19 survey, fewer than 20 women at risk of unintended pregnancy were not using contraception, so estimates for this indicator could not be made. In the later COVID-19 survey, 8% of non-users cited COVID-19-related reasons for not using contraception.
Stay-at-home restrictions + (hover to learn more)
Burkina Faso
During the earlier COVID-19 survey, Burkina Faso had a low number of COVID-19 cases and less strict stay-at-home orders (recommend staying at home). During the later COVID-19 survey, Burkina Faso was experiencing a steep increase in COVID-19 cases and there were no stay-at-home restrictions. In general, COVID-19 seemed to have little impact on women’s pregnancy desires and contraceptive use.
Click to see other indicators
Pregnancy Desires
Contraceptive Use
Switching to Less Effective or No Method
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Percentage of Women
Pregnancy Desires
23% of women reported that COVID-19 impacted their pregnancy desires in the earlier COVID-19 survey, but it dropped to 9% in the later COVID-19 survey.
Pregnancy Desires
Contraceptive Use
In the pre-pandemic survey, 38% of women were using contraception. This increased to 51% in the earlier COVID-19 survey and slightly decreased to 45% in the later COVID-19 survey, but remained higher than pre-pandemic levels.
Contraceptive Use
Switching to Less Effective or No Method
Between the pre-pandemic and earlier COVID-19 survey, 11% of women at risk of unintended pregnancy changed to a less effective or no method, and this slightly increased to 14% at the later COVID-19 survey.
Switching to Less Effective or No Method
COVID-19 Impact on Contraceptive Non-Use
At the earlier COVID-19 survey, only 3% of non-users reported COVID-19-related reasons for non-use, but this increased to 14% in the later COVID-19 survey.
Stay-at-home restrictions + (hover to learn more)
Côte d’Ivoire
The single COVID-19 survey took place from September to October 2020, when Côte d’Ivoire was under the least restrictive stay-at-home orders (recommended not to leave the house). During this time, COVID-19 cases were slightly increasing after a steep increase from June to July. COVID-19 seemed to have little impact on women’s pregnancy desires, and nearly 41% of women at risk of unintended pregnancy were using contraception. Among those not using contraception, just over one-quarter (26%) reported COVID-19-related reasons for contraceptive non-use.
Click to see other indicators
Pregnancy Desires
Contraceptive Use
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Percentage of Women
Pregnancy Desires
Only 4% of women reported changing their mind about wanting to become pregnant due to COVID-19-related reasons.
Pregnancy Desires
Contraceptive Use
41% of women at risk of unintended pregnancy were using any contraception at the survey.
Contraceptive Use
COVID-19 Impact on Contraceptive Non-Use
26% of non-users reported COVID-19-related reasons for non-use.
Stay-at-home restrictions + (hover to learn more)
Rajasthan, India
The single COVID-19 survey took place in Rajasthan, India, while COVID-19 cases were steeply rising from August through October 2020. During this time there were more restrictive stay-at-home orders in place (can leave the house for daily exercise, grocery shopping, and ‘essential’ trips). COVID-19 seemed to have very little impact on women’s pregnancy desires, and the majority of women at risk of unintended pregnancy were using contraception. However, among women who were not using contraception, almost half reported COVID-19-related reasons for contraceptive non-use.
Click to see other indicators
Pregnancy Desires
Contraceptive Use
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Percentage of Women
Pregnancy Desires
Only 5% of women reported changing their mind about wanting to become pregnant due to COVID-19-related reasons.
Pregnancy Desires
Contraceptive Use
75% of women at risk of unintended pregnancy were using any contraception at the survey.
Contraceptive Use
COVID-19 Impact on Contraceptive Non-Use
48% of non-users reported not using contraception because of COVID-19-related reasons.
Stay-at-home restrictions + (hover to learn more)
Kenya
When the earlier COVID-19 survey took place, Kenya had the most restrictive stay-at-home orders in place and very few COVID-19 cases. When the later COVID-19 survey took place, Kenya had more restrictive stay-at-home measures (can only leave house for daily exercise, grocery shopping, and ‘essential’ trips) and was experiencing a steep increase of COVID-19 cases. COVID-19 seemed to have little impact on women’s pregnancy desires and contraceptive use.
Click to see other indicators
Pregnancy Desires
Contraceptive Use
Switching to Less Effective or No Method
Percentage of Women
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COVID-19 Cases
Percentage of Women
Pregnancy Desires
At the earlier COVID-19 survey, 15% of women said they had changed their mind about becoming pregnant due to COVID-19 concerns, and this decreased to 5% at the later COVID-19 survey.
Pregnancy Desires
Contraceptive Use
Contraceptive use increased from 70% of women at risk for unintended pregnancy in the pre-pandemic survey to 81% in the earlier COVID-19 survey and decreased slightly to 75% at the later COVID-19 survey, but still remained higher than pre-pandemic levels.
Contraceptive Use
Switching to Less Effective or No Method
Between the pre-pandemic and earlier COVID-19 survey, 15% of women switched to a less effective or no method, and this slightly increased to 17% between the earlier and later COVID-19 survey.
Switching to Less Effective or No Method
COVID-19 Impact on Contraceptive Non-Use
At the earlier COVID-19 survey, 14% of non-users reported COVID-19-related reasons for contraceptive non-use, but this increased substantially to 48% at the later COVID-19 survey.
Stay-at-home restrictions + (hover to learn more)
Lagos, Nigeria
Lagos state was the epicenter of the pandemic. Non-essential government health services, including FP services, closed completely in Lagos from late March to late April 2020 before re-opening. The earlier COVID-19 survey happened in July 2020 while COVID-19 cases were slowly rising and there were more restrictive stay-at-home requirements (can only leave house for daily exercise, grocery shopping, and ‘essential’ trips). The later COVID-19 survey took place as cases were rapidly rising and stay-at-home orders were still more restrictive. COVID-19 seemed to have very little impact on women’s pregnancy desires and contraceptive use in Lagos, Nigeria.
Click to see other indicators
Pregnancy Desires
Contraceptive Use
Switching to Less Effective or No Method
Percentage of Women
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Percentage of Women
Pregnancy Desires
At the earlier COVID-19 survey, 7% of women said they changed their mind about becoming pregnant due to COVID-19 concerns, and this decreased to 4% at the later COVID-19 survey.
Pregnancy Desires
Contraceptive Use
Contraceptive use increased slightly over time: 61% of women at risk of unintended pregnancy were using contraception at the pre-pandemic survey, 62% at the earlier COVID-19 survey, and 66% at the later COVID-19 survey.
Contraceptive Use
Switching to Less Effective or No Method
The percent of women switching from a less effective or no method was about the same between the surveys: 15% between pre-pandemic and earlier COVID-19 surveys and 14% between the earlier and later COVID-19 surveys.
Switching to Less Effective or No Method
COVID-19 Impact on Contraceptive Non-Use
At the earlier COVID-19 survey only 2% of non-users cited COVID-19-related reasons for contraceptive non-use, but this increased to 13% at the later COVID-19 survey.
Stay-at-home restrictions + (hover to learn more)
Uganda
The single COVID-19 survey took place from September through October 2020. During this time, there were more restrictive stay-at-home requirements (can only leave house for daily exercise, grocery shopping, and ‘essential’ trips) and COVID-19 case numbers were starting to rise slightly faster than earlier in 2020. COVID-19 seemed to have very little impact on women’s pregnancy desires, and more than half of women who were at risk of unintended pregnancy were using contraception. Of the women who were not using contraception, only one-quarter said that this was because of COVID-19-related reasons.
Click to see other indicators
Pregnancy Desires
Contraceptive Use
Percentage of Women
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Percentage of Women
Pregnancy Desires
Only 8% of women reported changing their mind about wanting to become pregnant due to COVID-19-related reasons.
Pregnancy Desires
Contraceptive Use
57% of women at risk of unintended pregnancy were using any contraception at the survey.
Contraceptive Use
COVID-19 Impact on Contraceptive Non-Use
26% of non-users reported COVID-19-related reasons for non-use.
Stay-at-home restrictions + (hover to learn more)
Côte d’Ivoire
Burkina Faso
Lagos, Nigeria
Uganda
Kenya
Rajasthan, India
Some groups of women and girls may need more targeted support than others when designing and implementing FP interventions. For example, when compared to the total population of women, higher percentages of certain subgroups of women stated that they were not using contraception for COVID-19-related reasons, including:
Women with no children in Kinshasa, DRC (at the later COVID-19 survey)
Women in rural areas in Côte d’Ivoire
Women with 3 or more children and those who were 25-34 years old in Rajasthan, India
Women 35 years or older in Kenya (at the earlier COVID-19 survey)
Women under 25 years in Lagos, Nigeria (at the later COVID-19 survey)
Deeming SRH services “essential” — by WHO and national governments — was a critical first step to ensuring continuity of services. This included deeming certain contraceptive products as “essential medicines” or deeming SRH service providers as an essential service provider. Also, proactive management of FP commodities helped protect against stock-outs.
Despite its devastating effects, the COVID-19 pandemic provided a unique opportunity for implementers to pilot interventions that they may not have otherwise attempted, a number of which are anticipated to continue even once the situation has normalized due to their success.
Innovative data collection methods such as remote data collector training or phone interviews made it possible to understand and respond to the pandemic to inform FP programs.
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COVID-19 Impact on Contraceptive Non-Use
COVID-19 Impact on Contraceptive Non-Use
COVID-19 Impact on Contraceptive Non-Use
COVID-19 Impact on Contraceptive Non-Use
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COVID-19 Impact on Contraceptive Non-Use
COVID-19 Impact on Contraceptive Non-Use
COVID-19 Impact on Contraceptive Non-Use
COVID-19 Impact on Contraceptive Non-Use
Lagos, Nigeria
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Have women changed their minds about wanting to become pregnant because of COVID-19 concerns?
Through emergency funding, the Family Planning Association of Nepal (FPAN) quickly reestablished FP services early in the pandemic through walk-in services, outreach by CHWs, and telehealth consultations, resulting in comparable numbers of clients served as before the pandemic.
Did contraceptive use change during the first year of the COVID-19 pandemic?
Breakthrough ACTION and West Africa (WABA) adapted its FP public service announcements for a social and behavior change radio campaign to include messages about how to access safe services during the pandemic. Exposure to the campaign was associated with positive FP care-seeking attitudes and intentions.
Did COVID-19-related reasons impact women’s access to contraception?
The Madagascar Ministry of Health and DMPA-SC Access Collaborative successfully introduced and scaled up DMPA-SC self-injection through remote supervision of FP providers.
Were there differences among subgroups of women?
Through emergency funding, the Family Planning Association of Nepal (FPAN) quickly reestablished FP services early in the pandemic through walk-in services, outreach by CHWs, and telehealth consultations, resulting in comparable numbers of clients served as before the pandemic.
What lessons can be applied to future pandemics or crisis situations to ensure continuity of FP services?
Breakthrough ACTION and West Africa (WABA) adapted its FP public service announcements for a social and behavior change radio campaign to include messages about how to access safe services during the pandemic. Exposure to the campaign was associated with positive FP care-seeking attitudes and intentions.
COVID-19’s impacts on contraceptive use during the first year of the pandemic may not have been as severe as originally feared.
PMA
PMA
PMA
About the Data
The Data
Program Adaptations
Key Implications
Downloadable Data and Other Links
USAID in Africa flickr
JSI, Inc.
Breakthrough ACTION
JSI, Inc.
World Bank / Ousmane Traore
FPAN
USAID in Africa flickr
RH Supplies Coalition on Unsplash
Jonathan Torgovnik/Getty Images/Images of Empowerment
Connecting the Dots between Evidence and Experience
Download the case study
Download the case study
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COVID-19 Impact on Contraceptive Non-Use
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COVID-19 Impact on Contraceptive Non-Use
Pregnancy Desires
Contraceptive Use
COVID-19 Impact on Contraceptive Non-Use
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COVID-19-related reasons
COVID-19 Impact on Contraceptive Non-Use
COVID-19-related reasons
Click on the pink dots to see the data
Kinshasa, DRC
Rajasthan, India
Kenya
Burkina Faso
Côte d’Ivoire
Uganda