Factors that influenced access and utilisation of sexual and reproductive health services among Ugandan youths during the COVID-19 pandemic lockdown: An online cross-sectional survey

Abstract

BackgroundThe COVID-19 pandemic has caused a wide range of disruptions in health care access in many low and middle income countries. The aim of this study was to explore factors that influenced access and utilisation of sexual and reproductive health services among Ugandan youths during the COVID-19 pandemic lockdown. MethodsThis was an online cross-sectional study carried out from April 2020 to May 2020 in Uganda. An online questionnaire was used and participants aged 18years to 30 years were recruited using the snowballing approach. The statistical analysis was done using STATA version 14.2.Results Out of 724 participants, 203 (28%) reported not having information and/or education concerning sexual and reproductive health (SRH). About a quarter of the participants (26.9%, n=195) reported not having access to testing and treatment services of sexually transmitted infections during the lockdown. Lack of transport means was the commonest (68.7%) limiting factor to accessing SRH services during the lockdown followed by the long distance from home to SRH facilities (55.2%), high cost of services (42.2%) and curfew conditions (39.1%). Sexually transmitted infections were the commonest (40.4%) problems related to SRH during the lockdown followed by unwanted pregnancy (32.4%) and sexual abuse (32.4%). Limiting factors were more prevalent among the co-habiting youths [CPR: 1.3 (1.13-1.49) and APR:1.2 (1.06-1.41)] followed by unemployed [CPR: 1.3 (1.09 - 1.53) and APR:1.2 (1 - 1.42)] and non-salaried [APR:1.2 (1- 1.42)] than other participants. The bivariate and multivariate regression analyses indicate that problems were more prevalent among the co-habiting youths [CPR: 2.7 (1.88 - 3.74) and APR: 2.3 (1.6 - 3.29)] followed by the unemployed [CPR: 2 (1.27 - 3.2) and APR: 1.6 (1.03 - 2.64)] than in other categories. ConclusionThe findings of this study show that Ugandan youths had limited access to SRH information and services during the COVID-19 lockdown. Cohabiting and unemployed youths were the most affected by problems related to SRH. Lack of transport means and high cost of services were the major limiting factors to access SRH services among the youths. The findings call for concerted efforts from the Government and other stakeholders to incorporate SRH among the priority services when designing responses to any outbreak crisis.

Impacts of COVID-19 on contraceptive and abortion services in low- and middle-income countries: a scoping review

“…Twenty-six studies addressed impacts of COVID-19 on abortion and/or PAC in terms of demand, provision, access, or outcomes; 34 , 38–41 , 45–47 , 51 , 52 , 54 , 55 , 62 , 63 , 66 , 69 , 71–74 , 76–78 , 87–89 46% were peer-reviewed. The studies ranged widely in geographic coverage from a single town or facility to a multi-regional study covering 118 countries.…”

“…Sixteen studies reported on abortion-related outcomes, 34 , 38 , 55 , 62 , 66 , 69 , 71–74 , 76–78 , 87–89 seven of which covered PAC. 34 , 66 , 72 , 74 , 76 , 77 , 88 Several representative or large-scale studies reported decreases in safe abortion services during COVID-19.…”

“…Sixteen studies reported on abortion-related outcomes, 34 , 38 , 55 , 62 , 66 , 69 , 71–74 , 76–78 , 87–89 seven of which covered PAC. 34 , 66 , 72 , 74 , 76 , 77 , 88 Several representative or large-scale studies reported decreases in safe abortion services during COVID-19. Three studies using representative HIS data that mainly capture public sector services (in Nepal, India, and Mexico City) reported decreases of 20–40% in the number of abortions.…”

“…Seven studies reported on the impact of COVID-19 on postabortion outcomes. 34 , 66 , 72 , 74 , 76 , 77 , 88 There are no systematic patterns in the direction of the impact, likely because of differences in contexts, including the extent to which the pandemic impacted the provision of safe abortion and PAC services, the demand for abortion, and the quality of data. Using national HIS data for Kenya, one study found no significant changes in PAC caseload, pre- and post-COVID-19 (March–June 2019 versus March–June 2020).…”

“…72 A non-representative, small-scale study of young people in Uganda found that 21% of the 24 women who had an abortion were unable to access PAC services. 66 …”