Access to contraceptive services during the COVID-19 pandemic: clients' perspective at primary health care level from India, Nigeria and Tanzania.

Background: The COVID-19 pandemic disrupted the provision of sexual and reproductive health services, including contraceptive and family planning (FP) services. The World Health Organization conducted a multi-country study in India, Nigeria and Tanzania to assess the impact of the pandemic on the health system's capacity to provide contraceptive and FP services. In this paper, we share the results of a qualitative study aimed at understanding clients' perspectives at the primary healthcare level on accessing contraceptive services in COVID-19-affected areas in the three aforementioned countries.

Methods: We conducted interviews with 644 clients seeking contraceptive services across 11, 6 and 33 primary health facilities in India, Nigeria and Tanzania. A total of 44 focus group discussions (FGDs) and 128 in-depth interviews were conducted with clients at the facility and 22 FGDs within the community. Data collection took place from May 2022 to August 2022. Ethical approval was obtained from the WHO Ethics Review Committee and national regulatory bodies. All interviews were analysed using the general approach of content analysis.

Results: Clients at primary health care facilities faced several challenges in accessing contraceptive services. These challenges were grouped into two main categories. The first was related to the unprepared health system (supply), such as a shortage of health workers, stock out of contraceptives or high cost of FP services. The second category was outside the remit of the health system and included insufficient knowledge amongst clients about the availability of FP services, socio-cultural issues like spousal and in-laws' dominance on decision making, restriction in movement due to lockdown and fear of COVID-19 infection.

Conclusions: This study highlights the obstacles clients faced in accessing contraceptives during the COVID-19 pandemic in Nigeria, India, and Tanzania. To address these barriers in future crises, ministries of health must establish functional emergency preparedness across all healthcare levels. These plans should prioritize both on the sufficient number/gender of skilled health providers and the availability of contraceptives till the last mile. Utilizing e-health can help keep communities well informed on where, how and when to avail FP services during such emergencies. Health educational programs should actively engage men to gain further support.