Family Planning During and After the West African Ebola Crisis

The West African Ebola outbreak of 2013–2016 caused over 11,000 deaths (World Health Organization 2016a) and devastated the already fragile health systems of Liberia, Sierra Leone, and Guinea. During the crisis, staffing shortages, quarantines, interruptions to supply chain, health facility closures, and fear of health facilities and workers resulted in significant disruptions to the provision and utilization of a range of health services, including inpatient health services and surgery (Bolkan et al. 2014), malaria treatment (Plucinski et al. 2015), vaccinations (Barden-O’Fallon et al. 2015), obstetric care (BardenO’Fallon et al. 2015; UNWomen 2014), and family planning (Barden-O’Fallon et al. 2015; UNWomen 2014; Camara et al. 2017).

The United Nations (UN) released a Gender Alert in February 2015 noting that reduced access to contraceptives as a result of the Ebola crisis would put women at an increased risk of unintended pregnancy (UN Women 2014). Given the risks of unintended pregnancy and the high rates of maternal and child mortality in the three affected countries prior to the Ebola crisis, the disruption of these services and potential gaps in contraceptive coverage risked Avenir Health, Glastonbury, CT, USA. Family Planning before and after Ebola Crisis rollbacks in recent advances in contraceptive use and maternal and child health. A study of the impact of Ebola on reproductive health care in one district in Guinea found a 50 percent decline in family planning visits during the height of the crisis (Camara et al. 2017). Prior to the crisis, Liberia and Sierra Leone had seen gains in expanding contraceptive prevalence, rising from 12 to 21 percent of all women in Liberia between 2007 and 2013 (Liberia Institute of Statistics and Geo-Information Services 2008, 2014) and 8 to 21 percent in Sierra Leone between 2008 and 2013 (Statistics Sierra Leone 2009, 2014). Guinea’s prevalence remained low and relatively constant (Institut National de la Statistique/Guinée and ICF International 2013), only increasing from 6.8 to 7.0 percent between 2005 and 2012. Because of the lack of digital government service statistics before and during the epidemic, we do not include Guinea in our analysis. Understanding the impact of the crisis on family planning provision is essential for future efforts to expand access to contraception in these countries and better safeguard against negative impacts of future crises.