Disruption and recovery of family planning, contraception and other sexual and reproductive health services in Brazil with COVID-19 pandemic: a mixed methods approach

Limited scientific evidence is available on the impact of COVID-19 on Sexual and Reproductive Health (SRH). Some data shows that severe disruptions in SRH services expose women to preventable health risks. This study has the objective to provide a better understanding of the impact of COVID-19 on family planning and contraception among other SRH services and strengthen policies and services to be more responsive to community needs. A mixed quantitative and qualitative methods were used to assess SRH service availability and readiness, and clients’ and providers’ perceptions in some Brazilian COVID-19-affected areas. Interviews were performed at baseline and 6–9 months later. It was conducted in three cities from the São Paulo state, Campinas, Jundiai, and Santos. The health facility level involved five questionnaires for assessment of infrastructure availability and readiness to provide SRH services and a qualitative survey to elicit health services providers´ perspectives. The qualitative in-depth interviews (IDI) with the participants and Focus Group Discussion (FGD) with women and partners were conducted using a semi-structured interview, recorded and transcribed. A thematic content analysis was then performed. The settings studied had different characteristics of geographic size, population, and organisation of health services that influenced the way they faced COVID-19. During the baseline interview, the population mentioned fear of seeking health support in the PHU; however, this situation was still observed in Santos in the end-line interview. Antenatal and post-partum care was offered to the population; however, other demands, such as contraception were not. In the interviews, contraception services were considered a priority. The different speeches and behaviours of the government leaders caused discredit to the health measures recommended by the WHO. There is a need for alignment among health managers at municipal, state, and federal levels. The municipal administration played a key role in the fight against COVID-19 together with the coordinators of the health services. Contraception was not considered a priority during the pandemic. However, participants reported they should be considered essential services in future pandemics. The PHU readiness offered antenatal and post-partum care, while other population needs were not prioritized. The objectives of this study were to assess the impact of COVID-19 on family planning and contraception and to strengthen policies and services to be more responsive to community needs in Brazil. We used mixed quantitative and qualitative methods to assess SRH service availability and readiness, and clients’ and providers’ perceptions in three COVID-19-affected areas. Interviews were performed at baseline and 6–9 months later. We used five questionnaires for assessing infrastructure availability and readiness to provide SRH services and a qualitative survey to capture health service providers´ perspectives. The qualitative in-depth interviews (IDI) and Focus Group Discussions (FGD) with women and partners were conducted using a semi-structured interview. A thematic content analysis was then performed. The settings had different characteristics influencing the way they faced COVID-19. During the baseline interview, the population mentioned fear of seeking health support in the PHU; however, the same was still observed in one city in the end-line. Antenatal and post-partum care was offered to the population; however, contraception that was considered a priority was not. Contradictory speeches of the government leaders caused discredit to the health measures recommended by the WHO, evidencing the need for alignment among health managers at all levels. The municipal administration plus the coordinators of the health services played a key role in the fight against COVID-19. Contraception was not considered a priority during the pandemic, although participants said they should be essential in future pandemics. The PHU readiness offered antenatal and post-partum care, while other population needs were not prioritized.