Doing Things Differently: What It Would Take to Ensure Continued Access to Contraception During COVID-19

The dentist holds birth control pills

Key Messages

  • COVID-19 may fundamentally change women’s contraceptive use, thus altering the range of supplies that will be required in the near term. Policy makers will need to consider country realities and explore service delivery adaptations to meet these changing needs. Existing data can quantify potential shift in contraceptive use to help inform decisions.
  • Donors, policy makers, and program planners may need to revisit supply plans and the use of financing to ensure that contraception is effectively sustained.

Since the start of the coronavirus disease (COVID-19) pandemic, the family planning community has focused their attention on mitigating the devastating consequences of failing to meet women’s needs for contraception. Recent estimates by the Guttmacher Institute suggest that with even just a 10% decline in use of shortterm and long-acting reversible contraceptives (LARC) across 132 low- and middle-income countries, unmet need for contraception would increase by 48.6 million women and lead to 15 million additional unintended pregnancies. That risk grows each day as reports come to light of clinic closures, the reduced mobile outreach services and declines in the number of clients attending even open clinics.

To ensure women’s access to a full range of methods as well as removal services, we have seen calls from across the RH community to safeguard the integrity of existing service delivery systems and the supply chains that support them. These calls are critical and they are welcome. But in environments where these systems face pressure or cease to function altogether, different solutions are being proposed, such as those made by Nanda et al. in this issue of GHSP. They outline approaches such as minimizing family planning clientprovider contact through use of telehealth and integration into other essential services (same-day postpartum family planning). They also consider extended use of LARCs, options for method switching, and changing dispensing guidelines in the event disruptions are encountered. Many of the suggestions in their piece have also been echoed elsewhere.

COVID-19 is fundamentally changing the contraceptive landscape, and by extension, the ability of national programs to meet women’s immediate needs for contraception. The future for which we have been planning and procuring will not be, in all likelihood, the reality we see before us in the coming 12–18 months. It is a mistake, therefore, to call for supply chains to continue feeding programs with a mix of supplies that they may no longer be capable of delivering. COVID-19 is raising a host of important questions about the relationship between product and program. In these unprecedented times, we must rethink the ways we link products and programs to ensure continuity in women’s access to contraception.

To add context to these policy discussions, we have attempted to quantify potential shifts in contraceptive use that could result from some of the mitigation strategies we have outlined. We focus on the mitigation strategies most likely to reflect the availability of contraceptive options under COVID-19 to highlight the implications of such changes.