Exploring the effects of COVID-19 on family planning: results from a qualitative study in rural Uganda following COVID-19 lockdown.
Exploring the effects of COVID-19 on family planning: results from a qualitative study in rural Uganda following COVID-19 lockdown.
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DOI：
10.1186/s12978-023-01566-3
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发表时间：
2023-02-09
影响因子：
3.4
通讯作者：
Kiene, Susan M.
中科院分区：
文献类型：
--
作者：
Sileo, Katelyn M.;Muhumuza, Christine;Helal, Teddy;Olfers, Allison;Lule, Haruna;Sekamatte, Samuel;Kershaw, Trace S.;Wanyenze, Rhoda K.;Kiene, Susan M.
COVID-19 大流行可能影响了低收入和中等收入国家本来就很高的未满足的计划生育需求。这项定性研究使用 Andersen 的卫生服务使用行为模型作为理论框架，探讨了 COVID-19 大流行（包括政府强制封锁 3 个月的影响）可能影响乌干达农村地区计划生育结果的可能方式。第二个目标是提出在 COVID-19 背景下改善计划生育服务提供的建议。 2020年6月至10月期间，我们分别与计划生育需求未得到满足的男性和女性（N = 26）进行了四次焦点小组讨论，并对社区领导和计划生育利益相关者进行了15次关键信息访谈。使用主题分析对数据进行分析。我们发现，新冠肺炎 (COVID-19) 严重扰乱了计划生育服务的提供，对避孕药具的使用和意外怀孕的风险具有潜在的负面影响。 COVID-19 对个人有利因素（例如家庭收入）和社区有利因素（例如交通障碍和通过村卫生队和流动诊所提供的基于社区的计划生育服务的中断）产生了负面影响。参与者认为，COVID-19 封锁限制加剧了与贫困和性别不平等相关的现有背景诱发因素，例如亲密伴侣暴力和权力不平等，这些因素削弱了女性拒绝与丈夫发生性行为的能力以及使用避孕药具的自主权。在 COVID-19 背景下改善计划生育服务提供的建议集中于应急准备、加强社区卫生系统以及创造新方法，在未来的 COVID-19 封锁期间安全地直接向社区提供收缩方法。这项研究强调了 COVID-19 封锁对计划生育分配的影响，以及性别不平等的加剧，限制了妇女在怀孕预防措施方面的自主权。为了提高 COVID-19 背景下计划生育服务的利用率，需要加强应急准备和响应，利用社区结构提供避孕药具，并解决影响护理寻求和服务利用的潜在性别不平等问题。本研究探讨了 COVID-19 大流行和政府强制封锁乌干达农村地区获得计划生育服务的障碍为期 3 个月的潜在影响，并提出了在未来发生 COVID-19 限制时改善服务提供的建议。数据收集自四次焦点小组讨论，分别与计划生育需求未得到满足的男性和女性 (N = 26)，以及对社区领导和计划生育利益相关者的 15 次访谈。由于 COVID-19，计划生育服务的提供受到干扰，对社区成员获得服务的能力产生了负面影响，例如减少了他们的收入。 COVID-19 还扰乱了社区和卫生系统的服务分配，例如交通禁令以及通过村卫生队和流动诊所暂停所有基于社区的计划生育服务。参与者认为，COVID-19 的封锁限制加剧了亲密伴侣暴力，而且随着男性更多地呆在家里，女性在伴侣不知情的情况下使用避孕药具的能力受到限制，并导致伴侣之间发生更多性行为，而女性无法拒绝。总的来说，这些后果被认为会增加女性意外怀孕的风险。在 COVID-19 背景下改善计划生育服务提供的建议集中于改善卫生系统对紧急情况的响应以及在未来的 COVID-19 封锁期间直接向社区安全地提供避孕方法的措施。以社区为基础的计划生育的成功实施将取决于提高男性对计划生育的接受度的努力，同时解决削弱女性怀孕时间和间隔能力的潜在性别不平等问题。
The COVID-19 pandemic has likely affected the already high unmet need for family planning in low- and middle-income countries. This qualitative study used Andersen’s Behavioral Model of Health Service Use as a theoretical framework to explore the possible ways in which the COVID-19 pandemic, including the impact of a 3-month government mandated lockdown, might affect family planning outcomes in rural Uganda. A secondary aim was to elicit recommendations to improve family planning service delivery in the context of COVID-19. Between June and October 2020, we conducted four focus group discussions with men and women separately (N = 26) who had an unmet need for family planning, and 15 key-informant interviews with community leaders and family planning stakeholders. Data were analyzed using thematic analysis. We identified a significant disruption to the delivery of family planning services due to COVID-19, with potential negative effects on contraceptive use and risk for unintended pregnancy. COVID-19 had a negative effect on individual enabling factors such as family income, affecting service access, and on community enabling factors, such as transportation barriers and the disruption of community-based family planning delivery through village health teams and mobile clinics. Participants felt COVID-19 lockdown restrictions exacerbated existing contextual predisposing factors related to poverty and gender inequity, such as intimate partner violence and power inequities that diminish women’s ability to refuse sex with their husband and their autonomy to use contraceptives. Recommendations to improve family planning service delivery in the context of COVID-19 centered on emergency preparedness, strengthening community health systems, and creating new ways to safely deliver contractive methods directly to communities during future COVID-19 lockdowns. This study highlights the consequences of COVID-19 lockdown on family planning distribution, as well as the exacerbation of gender inequities that limit women’s autonomy in pregnancy prevention measures. To improve family planning service uptake in the context of COVID-19, there is a need to strengthen emergency preparedness and response, utilize community structures for contraceptive delivery, and address the underlying gender inequities that affect care seeking and service utilization. This study explored the potential impact of the COVID-19 pandemic and a 3-month government mandated lockdown on barriers to accessing family planning services in rural Uganda, and recommendations to improve service delivery in the event of future COVID-19 restrictions. Data were collected from four focus group discussions with men and women separately (N = 26) who had an unmet need for family planning, and 15 interviews with community leaders and family planning stakeholders. The delivery of family planning services was disrupted due to COVID-19, negatively affecting community members’ ability to access services, such as by reducing their income. COVID-19 also disrupted community and health system distribution of services, such as through a transportation ban and the suspension of all community-based family planning delivery through village health teams and mobile clinics. Participants felt that COVID-19 lockdown restrictions worsened intimate partner violence, and with men at home more, limited women’s ability to use contraceptives without their partner’s knowledge and resulted in more sex between partners without women being able to refuse. Taken together, these consequences were thought to increase women’s risk of unintended pregnancy. Recommendations to improve family planning service delivery in the context of COVID-19 centered on measures to improve the health system’s response to emergencies and to safely deliver contraceptive methods directly to communities during future COVID-19 lockdowns. The successful implementation of community-based family planning will depend on efforts to increase men’s acceptance of family planning, while addressing underlying gender inequities that diminish women’s ability to time and space pregnancy.
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影响因子：
6
作者：
Church K;Gassner J;Elliott M
通讯作者：
Elliott M
DOI：
10.3205/psm000089
发表时间：
2012
期刊：
Psycho-social medicine
影响因子：
--
作者：
Babitsch B;Gohl D;von Lengerke T
通讯作者：
von Lengerke T
影响因子：
4.8
作者：
Bakeera, Solome K.;Wamala, Sarah P.;Pariyo, George W.
通讯作者：
Pariyo, George W.
影响因子：
--
作者：
Dasgupta, Aisha;Kantorova, Vladimira;Ueffing, Philipp
通讯作者：
Ueffing, Philipp
影响因子：
5
作者：
ANDERSEN, RM
通讯作者：
ANDERSEN, RM