Assessing changes in adolescent girls’ and young women’s sexual and reproductive health service utilisation following a COVID-19 lockdown in eSwatini

ABSTRACT

The effects of COVID-19-associated restrictions on youth sexual and reproductive health (SRH) care during the pandemic remain unclear, particularly in sub-Saharan Africa. This study uses interrupted time series analyses to assess changes in SRH care utilisation (including visits for HIV testing and treatment, family planning, and antenatal care) adolescent girls’ and young women’s (AGYW; aged 15–24 years old) in eSwatini following COVID-19 lockdown beginning in March 2020. SRH utilisation data from 32 clinics in the Manzini region that remained open throughout the 2020 COVID-19 period were extracted from eSwatini’s electronic health record system. We tabulated and graphed monthly visits (both overall and by visit type) by AGYW during the two-year period between January 2019 and December 2020. Despite the March to September 2020 lockdown, we did not detect significant changes in monthly visit trends from 2019 to 2020. Our findings suggest little change to AGYW’s SRH utilisation in eSwatini during the 2020 COVID-19 lockdown period.

KEYWORDS:

• COVID-19
• sexual and reproductive health
• primary care utilization
• adolescent girls and young women
• eSwatini

Responsible editor

Jennifer Stewart Williams

Responsible editor

Jennifer Stewart Williams

Acknowledgments

The authors thank the eSwatini Ministry of Health for making the de-identified data available, and Project Last Mile for their earlier support and collaboration on the parent study.

Author contributions

MAB, ELL, and MMD designed the study, with input from all other authors. MAB, ELL, MMD, and SC wrote the proposal for the funding for the project. MMD obtained the funding for the study. TMG extracted the data from the health system. MEC conducted the analyses, with support from MAB, AJ, TMG, ELL, and MMD. MAB wrote the first draft, with input and revisions from all authors. All authors have also read and approved the final manuscript.

Ethics and consent

Approvals were obtained from the eSwatini Ministry of Health and the Yale University Institutional Review Board (IRB). As all data was de-identified, Yale deemed the study ‘not human subjects research.’

Disclosure statement

No potential conflict of interest was reported by the author(s).

Paper context

Young women in Southern Africa face significant barriers to sexual and reproductive health (SRH) care access and use. It is unclear how COVID-19 lockdowns may have further influenced their use of care. We assessed adolescent girls’ and young women’s utilisation of SRH services in eSwatini before, during, and after COVID-19 lockdowns in 2020, and found that SRH utilisation remained consistent throughout. Future research should explore how clinics sustained service delivery during this time.

Supplementary data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/16549716.2023.2243760

Additional information

Funding

This work was funded by a Yale University Whitney and Betty MacMillan Center for International and Area Studies Faculty Research Grant awarded to Mayur Desai. At the time of the study, Marie Brault was funded by grants K01TW011480 and K01TW011480-02S1 from the Fogarty International Center at the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the views of the funders.