More women seeking abortion, contraceptives during lockdown

A largely expected baby boom due to Covid-19 restrictions, in place since March, may have been averted.

Data from hospitals across the country show that from the onset of the protocols, many women took decisive measures to protect themselves against unplanned pregnancies.

A recent study by Liverpool School of Tropical Medicine – Kenya and UK offices, and the University of Nairobi reports higher than usual uptake of contraceptives during the Covid-19 partial lockdown.

Data shows that the most popular were short-term contraceptives, including oral pills and injectables, among those who took protection.

The researchers, led by Duncan Shikuku, analysed hospital attendance and reproductive health services data from the Kenya Health Information System (KHIS).

KHIS, previously known as DHIS2, is a national digital platform through which all health facilities report to the Ministry of Health on all their activities on monthly basis.

At the outbreak of Covid-19 it was estimated that the world would see about 15.5 million additional unintended pregnancies due to the disruption of health services.

“But data shows mild disruptions in Kenya,” suggests the study posted in Medrxiv last month.

The team compared data on provision of reproductive health services for the months of March to June, when Kenya was under partial lockdown and a similar period last year.

Overall, the study found no significant change in the mean total hospital attendance for all reproductive health services. This included antenatal care, skilled birth, family planning, and post-abortion care and immunization services.

“However, the trends across the services showed a dip in April 2020 before eventually rising in May and June reaching and/or even surpassing the four-month pre-Covid-19 period.”

But there was a significant divergence in the utilisation of the services before and during the pandemic such as a significant spike in the use of contraceptives and more caesarean births.

For example, while there were about 1.7 million family planning visits between March and June last year this increased to about 1.8 million during the first four lockdown months.

There was an increase in the number of women seeking family planning services in all reproductive ages with the highest spike among women aged 20-24.

There were about 5,000 more girls aged 10 to 19 who sought family planning services during the partial lockdown compared to the same period last year.

During the first four months of the partial lockdown 11,592 girls aged 10-14 sought family planning services, slightly more than in the same period last year. The data shows no change in the use of morning-after pills during the study period and a significant drop in demand for long-term methods such as implants and the coil.

On the other hand, the highest spike in demand was registered with the short-term injectable and oral pills.

“There was a significant increase in the proportion of women aged 10 to 24 seeking family planning services during the lockdown,” says the study.

But despite the higher utilisation of contraceptives Shikuku says Kenya is likely to see slightly more births than usual from November to March as the full impact of the lockdown is realised.

“Normally in November and December there are fewer deliveries but due to the lockdown we are likely to see a slight bump,” Shikuku told The Standard on Tuesday.  

At the same time, there was a drop in the proportion of pregnant girls aged 10-14 visiting health facilities during the partial lockdown period compared to a similar period last year.

More pregnancies among young girls

In March to June last year 6,872 girls aged 10-14 had presented to health facilities with pregnancies compared to 4,971 during the lockdown period.

But unlike last year when the month-to-month number of pregnant girls in this age group was a plateau, during the partial lockdown it was on an incremental trajectory.

“If this trend persists, recent gains achieved in maternal and perinatal health will be lost,” said Shikuku.

The number of adolescent girls seeking post-abortion services went down during the study period, but with a corresponding increase among older women.

During the first four partial lockdown months, data show there were 398,538 facility births; a slight increase over the same period last year.

However, almost 16 per cent of these were caesarean births, which was slightly higher than in the same period in 2019.

This is cause for worry, say the researchers. “The caesarean section rates during the Covid-19 period are steadily rising beyond the World Health Organisation’s recommendation of not more than 10-15 percent.”

More stillbirths

While high caesarean births should be accompanied by fewer stillbirths, this, the study says, has not been the case during the Covid-19 period in Kenya.

“There has been an unexpected rise in the fresh stillbirths which could reflect falling standards of quality of care during labor and childbirth in the health facilities during the pandemic,” says the study.

The data shows largely uninterrupted reproductive health services during the pandemic, suggesting the previously projected baby boom may have been largely avoided.

“Only time will tell,” says Susan Mutei, a social worker in Umoja, Nairobi. “It depends on whether products such as the pills, were used correctly and consistently; but it is a good indication that women are taking control of their lives despite the pandemic.”